1,509 terms



Terms in this set (...)

what cell takes up bacteria from the ileum and present antigen to immune cells
M cell on peyer patch that will then secrete IgA
what is the histology of hashimoto tyroiditis
follicular destruction and germinal center formation
what fungi is seen with mucicarmine staining
cryptococcus neoformans
what is the defect in osteogenesis imperfecta
type 1 collage
osteoid production by osteoblast
what findings will you see in osteogenesis imperfecta
can be mistaken for child abuse
multiple fractures
may have teeth issue
blue sclera due to exposure of chorodial veins
hearing loss
genetics with osteogenesis imperfecta
COLA1A1 and COL1A2
what is celecoxib
selective cox 2 inhibitor, has anti-inflammation without impaired platelet function becuase the platelets express cox 1
how does adapative immunity prevent us from getting influenza
anti- hemagglutin
what does hemagglutin do
promote influenza viral injury
what does neuramindase do
promote progeny virion release
what is akathisia
extrapyramidal symptom of antipsychotic that present with inability to sit or stand still in one position
what is in the cavernous sinus
CN III, IV, V1, V2, V1
what is germinal martrix hemorrhage
happen when baby born young, present with altered level of consciousness, hypotonia, bulging anterior frontanelle with a lot of bleeding
how does phase 4 depolarizarion in cardiac pacemaker work
closure of repolarizing K channel, slow influx of Na through funny channel, opening of T type Ca channel
what is the action of timolol
non selective beta blocker
effect of timolol on the eye
antagonize beta 2 receptor on ciliary epithelium which decrease aqueous humor
how do beta blocker help with hyperthyroidism
hyperthyroidism cause an upregulation of beta adrenergic receptor, hence we wanna block that
beta blocker also block the conversion of T4 to T3
Medulloblastoma- who is it seen most in and what are the histology
seen in kids
really malignant, affect cerebellum
histology show small blue cell
warfrin can cause what skin effect
skin necrosis via the thrombotic occlusion in the microvassculature
Neutrophils have...
name 2 things
myeloperoxidase and beta glucuronidase
neutrophil chemotactic agents are
platelet activating factor
what can happen after chronic use of antipsychotic
tardive dyskinesia
involuntary movement after chronic use, lip smacking
what is important to regenerate in the anaerobic cycle, what does this do
we need to regenerate NAD+ we have convert glyceraldehyde 3 phos to 1,3 BPG
How do we regenerate NAD+
lactate dehydrogenase converting pyruvate to lactate
what is treacher collins pathology
issue with the first and 2nd arch
what are the mediators for fever
IL1, IL6, TNF, prostaglandin
what is seen with a diagnositic test for nontreponemal syphillus
antibody to cardiolipin-cholesterol lechtin antigen
what will be seen on midgut malrotation
formation of Ladd bands
6th week herniate through umbilical ring
10th week return to abdominal cavity and rotate around SMA
what does a mitral regurg sound like?
holosystolic blowing murmur
loudest at apex and radiates to the axilla
what does tricuspid regurg sound like
holosystolic murmur
radiates to the right sternal boarder
left dominant circulation of the heart
posterior descending/ interventricular artery arise from the left circumflex coronary artery
right dominant circulation
posterior descending/ interventricular artery arise from right coronary artery
what are the strep virdins bacteria
streptococcus mitis
streptococcus mutans
where are the baroreceptors
in the aortic arch and carotid sinus
what does the baroreceptor in the aortic arch respond to
increase in blood pressure, transmit info via vagus nerve to solitary nucleus
what does the baroreceptor in the carotid sinus respond to
increase and decrease in BP, transmit info via glossopharyngeal nerve to the solitary nucleus
what happen to barorecpetor in low blood pressure
decrease in atrial pressure -> decrease stretch-> decrease afferent baroreceptor firing -> increase in efferent sympathetic firing (via alpha 1` vasoconstrictrion and beta 1 contractility) and decrease efferent parasympathetic (via vagus nerve) stimulation -> vasoconstriction, increase in HR, increase in BP, increase in contractility
cohort study
look at person with an exposure and see if they get disease
case control study
compare people with and without disease and see if they have certain exposure
type 1 error
p value, significance levels
stating that there is an effect or difference when none exist
null hypothesis incorrectly rejected in favor of alternative hypothesis
type 2 error
statistical power is 1-beta
beta is the probability of making a type II error
stating that there is not an effect or different when one exist; null hypothesis is not rejected when it is in fact false
how do you decrease beta error
increase sample size
increase expected effect size
increase in precision of measurement
what is affected in wenicke

speech fluidity? comprehension? repetition?
speech fluidity- fluent
comprehension- impaired
repetition- impaired

the area affected in the superior temporal gyrus of temporal lobe
what is affected in conduction aphasia?

speech fluidity?
speech fluidity- fluent
comprehension- intact
repetition- impaired

due to damage arcuate fasciculus
what is I cell disease
inherited lysosomal storage disease, issue with the signaling of proteins to the lysosomes. instead they secreted extracellulary.

defect in N acetlyglucosaminyl-1 phoaphotransferase
what is the presentation of I cell disease
high plasma level of lysosomal enzymes
coarse facial features
restricted joint movement
clouded corneas
what is the antibody associated with pemphigus vulgaris
IgG antibody against demoglobin
affects the adhesion molecules that bind epidermal keratinocytes to one another
what is the antibody associated with bullous pemphigoid
IgG antibody against hemidesmosomes
what is the presentation of pemphigus vulgaris
type of blister
involve oral mucosa
nikolsky sign
flaccid blisters
involve the oral muscoa
immunofluorescence is net like/ reticular pattern
positive nikolsky sign- seperation of epidermis upon manual stroking of skin
what is the presentation of bullous pemphigoid
type of blister
involve oral mucosa
nikolsky sign
tense blister
does not involve the oral mucosa
immunofluorescence is linear pattern at epidermal- dermal junction
niklosky sign is negative- no seperation of epidermis upon manual stroking of skin
antibody for RA
IgM antibody against Fc portion of IgG
MORE specific- anti-cyclic cirtullinated peptide antibody
what innervate the Inferior pharyngeal constrictor muscle
vagus nerve (superior laryngeal branch)
what muscle does CN 9 innervate (glossopharyngeal nerve)? What does this do?
elevation of pharynx and larynx
what happens to amcetaminophin when we take too much of it?
create toxic NAPQI and deplete glutathione
why is glutathione important?
it allows for the conversion of reactive oxygen specific to water so less damage is done to issue
Glutathione needs to be in its reduced state to do this, once oxidized it will be reduced with NADPH
what is the presentation of acute intermittant porphyria?
painful abdomen
port wine colored urine
worse with p450 inducers, alcohol, and starvation
psychological issues
how do you treat acute intermittant porphyria
glucose and heme (inhibits aminolevulionic acid dehydrogenase)
what mutation can cause sideroblastic anemia? mode of transmission?
aminolevulinic acid synthase
x linked
what is that pathway for ubiquination
ubiquinated proteins get degraded via proteasome
what happens when we treat salmonella
prolong duration of bug in poop
what happens when we treat shigella
lessen duration of bug in poop
what type of response for live attenuated vaccine give
induce cellular (T cell) and humoral response (B cell)
what type of response for inactivated/ killed vaccine
humeral response (mostly B cell)
what are the toxoid vaccine
C. diptheriae toxoid
C. tetani toxoid
B. pertussis toxoid
how are very long fatty acid chains broken down
via peroxisome
what is the point of pulmonary surfactance
decrease alveolar surface tension- which prevents alveolar collapse
decrease lung recoil
increase compliance
what is slipped strand misreading
there are repeated sequences of a certain nucleotide and the copies of homologous chromosome bind out of registry and then cause excision of part of the DNA and future alternation of the protein.
this would shorten the protein and cause a frame shift mutation
what is underdeveloped in digeorges
3rd and 4th brachial pouch
what is mosaicisim
presence of genetically distinct cell lines in the same person
what causes a transesophageal hernia aka hiatal hernia
the fundus of the stomach protruding out of the diaphragm
what is the function of glucokinase
convert glucose to glucose 6 phosphate in the liver and beta pancreatic cell
what is the function of hexokinase
convert glucose to glucose 6 phosphate in most tissue minus the liver and beta pancreatic cell
what gene mutation is asssociated with maturity-onset diabetes of the young
what is michaelis menten constant
concentration of s substrate that is found when the reaction has reached half its maximum velocity
what is on the first pharyngeal arch
maxillary process-> maxilla and zygomatic bone

mandibular process -> meckel cartilage -> mandible, malleus and incus, sphenomandiular ligament

can also result in periauricular skin tags
what is the function of IkB on NF-kBb
releases NF-kB after undergoing phosphorylation
what happens if the posterior communicating artery is damaged
contralateral hemianopia with macular sparing
what can an aneurysm of the posterior communicating artery result in
occulomotor nerve palsy
what is complex seizures
impaired consciousness
symptoms are dependent on where the anatomical location of the seizure is
simple partial seizures
consciousness is spared
symptoms are dependent on the anatomical location of the seizure
myoclonic seizures
patients present with quick and repeitive jerks
tonic clonic
usually begins in tonic phase where there is a contraction of all muscles, the clonic phase is then followed and results in rhythmis jerking of the bilateral extremities
what is the difference between avoidant and schizoid personality disorder
avoidant- desires relationship with others

schizoid- content with social isolation
what can smoking do to stomach acid
increase stomach acid and decrease the amount of mucus made. bad if you want to reduce ulcers
what is an adverse effect to inhaled anesthetics and succinylcholine
malignant hyerperthermia
induced fever with severe muscle contractions
mutation in voltage sensitive ryanodine receptor cause increase Ca release from sacroplasmic reticulum, casing increase ATP and heat
disregard for and violation of rights of others, criminality, impulsivity
before the age of 18 this is called conduct disorder
lentigo maligna
mole that is assymetrical, differ in color, change in time

proliferation at epidermonal and dermal junction, good prognosis
what are the types of melanoma
superficial spreading
lentigo maligna
acral lentiginous
seborrheic keratosis
flat, greasy, pigmented squamous epithelial proliferation with keratin filled cyst
what is leser trelat sign
a sudden appearance of seborrheic keratosis, indicate a malignancy
what is the pathology associated with sarcoidosis
widespread noncaseating granulomas and elevated CD4/CD8 ratio
what hematological issue can happen with lupus
what are rouleaux formations and what are their significance
high ESR and multiple myeloma
what are the functions of oxytocin
stimulate labor
uterine contractions
milk let down
controls uterine hemorrhage
western blot
can look at protein
southern blod
look at DNA
northern blot
look at RNA
southwestern blot
look at DNA binding proteins
what type of pain is seen with diabetic neuropathy
what is a common site of fetal hydronephrosis that is obstructive
ureteropelvic junction
what is the function of C3b
inactivated influenza vaccine will do what
neutralizing antibodies against hemagglutinin antigen, which prevent virus from entering the cell
what are the functions of setroli cell
create anti-mullerian hormone which results in inovulation of parameonephric duct
also provides nutrients for spermatogenesis
what is the functoin of leydig cell
creates testosterone (which can be used to convert the wolffian duct to male internal genitalia
Also creates DHT via 5a reductase to allow for male external genitalia
what can coxiella burnetii cause
Q fever
high suspected if person works on farm
will have pneumonia and hepatitis
no rash
what will be seen on gross anatomy of primary TB
Gohn complex
affects 2 sites- lower lobe and ipsilateral lymph node
will become calcified overtime
what is the gross anatomy of secondary TB
simon focus-
apex of the lung, gets there via primary TB spreading by blood
can be calcified
how do you convert glucose 6 phosphate to 6 phosphogluconate
via G6PD
what is G6PD that rate limiting step for
pentose phosphate pathway
what are the quads attached to
tibial tuberosity
what would we see in gallstone ileus
small bowel obstruction with air in the gallbladder and biliary tree
what happens to our skin as we age
increased collagen crosslinking- however does not help overall because you are not making that much collagen
decrease collagen fibril and increase of collagen and elastin degradation
placenta accreta
placenta is atached to the myometrium
will present as postpartum hemorrhage that does not improve with medication or uterine massage
what never innervates the subprapubic area
illiohypogastric nerve
what does the ilinguinal nerve provide
sensation to upper and medial thigh and part of the external genitalia
what does the genitofemoral nerve do
provide cremasteric reflex and sensation to upper anterior thigh
what type of bladder issue will people with MS have
hypertonic bladder, due to lack of descending inhibitory control from upper motor neuron
what mediators cause systemic inflammatory response
IL-1, IL-6, TNF-a
what are the antibodies in goodpasture
alpha 3 chain type IV collagen
what organ is spared in polyarteritis nodosa
how do we test for a primary thyroid issue
what is the function of bcl-2
inhibits apoptosis and promotes survival of cell
what increases when we have oral glucose vs iv glucose
oral glucose will have a higher response to insulin level due to incretins glucagon like peptide and gastric inhibitory peptide

incretins are secreted in response to sugar containing meals
NF 2 chromosome issue and mode of inheritance
chromsome 22
NF 2 presentation
bilateral schwannoma
schwannoma is a
adult primary brain tumor
what is the marker for schwannoma
S 100
what stain can we use for glioblastoma multiforme
Glioblastoma can cross the....
corpus callosum
what bone is most commonly fractured when fall on outstretch hand
xray of carpal bones
what is a transamiation reaction
a reaction between amino acids and alpha keto acid
what is the co factor for transamination
vitamin B6- pyridoxal phosphate
what is tetrahydrobiopterin a cofactor for
the synthesis of tyrosine, dopamine, and serotonin
what is inhibited in the diphtheriae vaccine
exotoin B via IgG
how do we do glycogenesis
take pyruvate and go to oxaloacetate then phosphenolpyruvate then back to glucose
what does the external branch of superior laryngeal nerve innervate
cricothryoid muscle
what nerve and muscle are at risk of injury in a thyroidectomy
external branch of superior laryngeal nerve and the cricothryoid muscle
what are neoplastic polyp with a high risk of malignancy transformation
serrated and adenomatous polyp
which adenomatous polyp type is more dangerous for malignancy- villous or tubular
what muscle is innervated by the thoracodorsal nerve
latissimmus dorsi
how do we screen the stool for fat
sudan III stain
where are anal fissure below pectinate line located
posterior midline due to lack of perfusion
what does a high grade cervical intraepithelial neoplasia mean
immature basal cells go to epithelial surface
what does cervical carcinoma make
atypical cell invade basement membrane
what does low grade cervical intraepithelial neoplasia mean
atypical cell in the lower 1/3 of epithelium
atherosclerotic plaques predominate what type of arteries
large elastic artery
large to medium size muscular artery
what is the most affected location is atherosclerosis, name the rest of the affected vessels in descending order
abdominal aorta
coronary artery
popliteal artery
carotid artery
what is the site of b cell development in the lymph node
what is the site of T cell development in the lymph node
what is the cell marker for monocyte macrophage lineage
CD 14
what is the cause of cleft lip
failure of fusion of the maxillary and medial nasal process
what is the cause of cleft palate
failure of fusion of the lateral palatine shelves

failure of fusion of lateral palatine shelf
what is the presentation of treacher collins
mandibular hypoplasia, facial abnormalities
what is the Pierre robin sequence
micrognathia, glossoptosis, cleft palate, airway obstruction
Pierre Robin sequence pathology
issue with 1st and 2nd brachial arch
how does the EBV virus infect the body
infects B cells through CD 21
what does EBV show on blood smear
atypical lymphocytes on peripheral blood smear will show reactive cytotoxic T cell
what mononucleosis will have a negative monospot test
what is the monospot test
heterophile antibodies detected by agglutination of sheep or horse RBCs
what is meigs syndrome
triad of ovarian fibroma (bundle of spindle shaped fibroblast), ascities, hydrothorax
malignancy of trophoblastic tissues
no chorionic villi
increase in beta- hCG
shortness of breath, hemoptysis
hematogenous spread of lung
why do we have calicium oxalate stones with Chrons disease
there is impaired bile acid reabsorption in the terminal ilium, which means that the bile salts will bind to calcium in the small intestine and create soap which go out in the poop
the oxalate will get absorb and we have oxalate kidney stone
what are the characteristic of calcium oxalate
x ray
xray- radiopaque
CT- radiopaque
shape- envelope/ square
what are the characteristic of calcium phosphate stone
x ray
xray- radiopaque
CT- radiopaque
shape- wedge shaped prism
what vitamin issue can result in calcium oxlate stone
vitamin C abuse
what pH changes are associated with calcium oxlate stones
decrease in pH
what effect does prolong ACTH exposure on the adrenal gland
hyperplasia of the fasiculata and reticularis
what does the brachiocephalic vein drain to
jugular and subclavian vein
what does a blockage in brachiocephalic vein show
one sided arm and face swelling
what swelling will be in SVC syndrome
bilateral facial and arm swelling
what is the function of pilli in N, meningitis
colonization of the nasopharyngeal epithelium
what provides cutaneous innervation to the lateral foreman
musculocutaneous nerve
what provides cutaneous innervation of the medial forearm
medial antebrachial cutaneous nerve
what do T tubules do
transmit depolarization signal to trigger the release of calcium and induce muscle contraction

uniform distribution allows for coordinated muscle contraction
how do we get horner syndrome
compression of the superior cervical ganglion
what is buspirone mechanism of action
stimulates 5-HT 1a receptors
what is buspirone used for
generalized anxiety disorder
what is the benefits of buspirone
lack muscle relaxant or anti-convulsant properties
slow onset of action
carries no risk of dependence
what is the earliest manifestation of diabetic nephropathy
albumin in pee
what is the immunology seen with primary sclerosing cholangitis
what is the immunology seen with primary biliary cirrhosis
what is the pathology of primary sclerosing cholangitis
onion skin bile duct fibrosis
alternating strictures and dilation
what is the pathology of primary biliary cirrhosis
lymphocytic infiltration and granuloma
what will activation of nicotinic cholinergic receptor result in
immediate influx of Na and Ca and outflux of K
how do we treat cardiotoxicity of TCA
sodium bicarb
where are muscarinic receptors found
parasympathetic nervous system
where are nicotinic receptors found
sympathetic nervous system
nicotinic receptors are....
all excitory
muscarinic receptors are...
inhibtory and excitory
overactive bladder syndrome is caused by
uninhibited bladder contractions
why do we get mallory weiss syndrome
due to increased abdominal pressure
what happens with mallory weiss syndrome
mucosal lacerations at gastroesophageal junction due to severe vomiting
fructose intolerance
hereditary deficiency of aldolase B
cause a buildup of fructose-1- phospate in liver
what is the presentation of fructose intolerance
hypoglycermia, jaundice, cirrhosis, vomiting
what is the presentation of essential fructosuria
fructose in blood and urine
other than that the symptoms are asymptompatic
what is the enzyme affected in essential fructosuria
what arteries do charcot bouchard aneurysm affect
small vessels of the brain
what are the risk factors of charcot bouchard aneurysm
chronic hypertension
is charcot bouchard seen on angiogram
what are the symptoms of charcot bouchard
progressive neurological symptoms
what are the symptoms of saccular aneurym
sudden severe headache
how do you treat otitis media
amoxicillin and clavulante
when does central pontine myelinolysis happen
when we do a rapid correction of severe hyponatremia
what will be the presentation of central pontine myelinolysis
para and quadriparesis, dysarthria (issue speaking), dysphagia (issue swallowing)
which renal artery does the ACE inhibitor affect
efferent arteriole, causes vasodilation
Increase renal blood flow and decrease GFR
what does angiotensin II do on the renal artery
constrict efferent arteriole
what happens when we constrict efferent arteriole
increase in GFR
Decrease RBF
what happens when we contrict afferent arteriole
Decrease GFR
Decrease RBF
What drugs constrict afferent arteirole on kindey
What drugs dilate afferent arteriole on kidney
What bacteria are removed by the spleen
streptococcus pneumonia
haemophilus influenzae
neisseria meningitis
Down syndrome markers in newborn screening
decrease in alpha fetoprotein
increase in beta- hCG
Edward syndrome marker in newborn screening
decrease in alpha fetoprotrin
decrease in beta- hCG
What would indicate cancer metastasis on the brain
multiple masses on brain in junction of white and gray junction
due to region high vascularity and narrow diameter vessel
What is the marker for medullary carcinoma of the thyroid
What is the marker of epithelial tumor of the ovary
What is the marker of pancreatic andrenocarcinoma
CA 19-9
What is the the pathology of Paget Disease of Bone
increase osteoclastic activity followed by increased osteoblastic activity
Describe the bone quality in paget disease of bone
poor bone quality. increased bone density and alternating band of cortical thickening
What is the histological findings will be seen in basal cell carcinoma
palisading nuceli
What is the precursor to squamous cell carcinoma
Actinic keratosis- a scaly plaque
where are the cyst in ADPKD
cortex and medulla
where are the cyst in ARPKD
collecting duct
what is the mutation with ADPKD
chromosome 16- PKD1
chromosome 4- PKD2
where is the foramina of monro located
between lateral ventricle and 3rd ventricle
where is the lateral foramina of lushchka located
between 4th ventricle and CSF
where is the median foramen of magendie
between 4th ventricle and CSF
how do we absorb phosphate from the kidney
Na-phosphate cotransporter
what is the potential complications of MI between 0-24 hours
ventricular arrhythmia
heart failure
cardiogenic shock
what is the potential complications of MI between 1-3 days
post infection fibrosis pericarditis
what is the potential complications of MI between 3-14 days
free wall rupture -> tamponade
papillary muscle rupture -> mitral regurgitation
interventricular septal rupture
LV pseudoaneurysm
What is the complication of MI 2 weeks and out
Dressler syndrome- pericarditis, autoimmune
heart failure
true ventricular aneurysm
What type of seizures can be treated with phenobarbital
status epilepticus
What is the chromosome is affected VHL?
What chromosome is affected in NF1
chromosome 17
aortic arch- 1st
part of the maxillary artery
aortic arch-2nd
stapedial artery and hyoid bone
aortic arch- 3rd
common carotid artery and proximal part of internal carotid
aortic arch-4th, left
aortic arch
aortic arch-4th, right
right subclavian artery
aortic arch-6th
proximal part of pulmonary artery and ductus arteriosis (on left)
What is the embryological issue with patent ductus arteriosis
6th brachial arch
What murmur is heard with patent ductus arteriosis
machine like murmur
what abdominal finding is seen with downs
duodenal atresia and hirschsprung
what is covering the omphalacele
what is the population at risk for buerger disease
heavy smoker who start smoking early
what is the pathology of buerger
segemental thrombosis in arteries and vein
what is the presentation of buerger
peripheral ischemia, pain, faint pulse in small/medium artery, and gangrene in toe and finger
what are the side effects of TCA
anticholinergic effects- dry mouth, urinary retention
QT prolongation
what is the signs of PCP intoxication
tachycardia, dilation of pupil (mydriasis), nystagmus
what are the signs of amphetamine intoxication
tachycardia, dilation of pupil, NO nystagmus
how does TCA cause QT prolongation
inhibit fast Na channel in cardiac myocytes
what is the long term complication of rubeola virus
subsacute sclerosing panencephalitis- dementia and personality
what part of the pancreas is made by ventral pancreatic bud
precursor of uncinate process
inferior/ posterior portion of the head
major pancreatic duct
what part of the pancreas is made by the dorsal pancreatic bud
body, tail, and most of the head
what is the triad of plummer vinson syndrome
1. esophageal web
2. dysphagia
3. iron deficiency anemia
what is the weight is anorexia nervosa
low weight
what is the weight in bulimia nervosa
normal body weight
what causes enlarged coronary sinus
pulmonary hypertenison
what are class III anti-arrhythmic drugs
what is the MOA of class III anti-arrhythmic drug
block potassium channel and inhibit the outward potassium currents during phase 3 of the cardiac action potential
what are the 3 things that are degenerated in Friedreich atxia
1. spinocerebellar tract degeneration
2. dorsal column
3. dorsal root ganglia
what happens when the spinocerebellar tract is damaged
cerebellar ataxia
what does damage to the dorsal column/ dorsal root ganglia degeneration
position/ vibration sensation
what hormones use cAMP as a second messenger
ADH- V2 receptor
way to remember second messengers that use cAMP
what does cAMP activated in the second messenger pathway
protein kinase A
making an excuse for unacceptable feelings about an exam
example of rationalization
claiming the job was not important when we get fired
example of supression
not worrying about a big game until it is time to play
what is repression
intentionally withholding an idea or feeling from conscious awareness
what does the CFTR protein do
transmembrane ATP gated Cl channel
what are the signs of vit D overdose
hypercalcemia, loss of appetite, not really consciousness
what disease can cause vit D excess
granulomatous disease
why do granulomatous disease cause increase Vit D
increased activation of vit D by epitheloid macrophage

they express a-1 hydroxylase
where is the AV node located
endocardial surface of the right atrium, near the septal leaflet of the tricuspid valve
what can injury above the clavicle result in
damage to the lung pleura
boundary of the posterior triangle of the neck

what can be damage here
sternocleidomastoid muscle
trapezius muscle

accessory nerve
how do we get esophageal varices in portal hypertension
shunting of blood to left gastric vein
what can cause caput medusae in portal hypertension
shunting of blood to periumbilical veins
what can cause splenomegaly in portal hypertesion
shunting of blood to splenic RED pulp
where do aortic dissections type A happen
ascending aorta, at the sinotubular junction
where do aortic dissection type 2 happen
descending aorta
at the left subclavian artery
what leads to increase expiratory flow rates
increase elastic recoil and increased radial traction
what will Dubin Johnson syndrome present as
black liver
what is the histology of Dubin Johnson syndrome
dense pigment within lysosome
what is the defect in Dubin Johnsn
cannot excrete conjugated bilirubin
what is the defect in crigler-najjar
absent UDP- glucuronosyltransferse
what is the defect in gilbert syndrome
mildly decreased UDP-glucuronosyltransferase

may present in times of stress
what does UDP- glucuronosyltransferase do
conjugate bilirubin
why is there selective loss of albumin in minimal change disease
loss of foot process- loss of neg charge on basement membrane
what unwinds the DNA
what relaxes the tension of the DNA as it is being unwind
what coagulase bacteria are novobiocin sensitive
S. epidermidis
what coagulase negative bacteria is novobiocin resistant
S. saprophyticus
what is indicated in the treatment of alcohol withdrawl
what are the benzodiazepine
what is the mechanism of action of benzodiazepines
facilitate GABAa action by increasing the frequency of Cl channel opening
how to treat benzo overdose
flumenazil and its relation to benzo
competitive antagonist
mechanism of action of barbiturates
facilitate GABAa action by increase duration of Cl channel opening
what enzyme is affected in acute intermittent prophyria
prophoblinogen deaminiase
what enzyme is affected in polyporphyria cutanea tarda
uroporphyrinogen decarboxylase
what is the presentation of polyprophryia cutanea tarda
blistering cutaneous photosensitivity
what is the presentation of acute intermittent porphyria
painful abdomnet, port wine colored pee, polyneuropathy, psychological issues

worse with P450 inducer,alcohol,starvation
what is diagnostic for 21 hydroxylase deficiency
elevated 17-hydroxyprogesterone
what type of seizure is lamotrigine not used for
status epilepticus
what is the mechanism of action for lamotrigine
block voltage gated Na channel
what should you worry about with lamotrigine
Steven johnson sydnrome
which is more selective- spironolactone or epleronone
which would result in gynecomastia- spironolactone or eplerenone
what is thiazide diuretic
what are status epilepticus
seizure lasting more than 5 minutes
how do you treat acute status epilepticus
how do you prevent status eplipticus
what is the mechanism of action of phenytoin
block Na channel
what cellular structures are affected in malignant tumors that result in their malignant spread
what do integrin bind to
fibronectin, collagen, laminin
what does IL 4 do
class switch to IgE and IgG
what does IL 5 do
eosinophil chemotaxis
class switch IgA
maturation of B cell to plasma cell
what does IL2 do
T cell growth factor and CD8 T cell activator
what does Th1 make
IFN gamma and IL 2
what does Th2 make
IL4, IL5, IL 10
light microscope for membranous glomerulopathy
diffuse thickness of the glomerular basement on light microscopy without increase cellularity
what is the EM appearance of membranous nephropathy
spike and dome appearance with subepithelial deposits
what is the appearance of membranoproliferatie disorder
tram track appearance
what is the immune complex deposition of membranoprolierative glomerulonephritis
what are the fat soluble vitamins
what are the signs of Vit A deficiency
night blindness
dry, scaley skin
corneal ulceration
what are the diagnostic approach for strongyloides stercoralis
rhabditiform larvea in stool
how do you diagnose schistosoma infection
detect parasite egg in the stool
what diagnostic test use to ID enterobius vermicularis
perianal egg deposition
what is the diagnosis for flatworm infection
proglottids in the stool
what is the diagnosis for giardia lamblia and entameoba histolytica
trophozoites and cyst in the stool
what artery supplies the majority of the blood for the femoral head and neck
medial circumflex femoral artery
ACL attaches
lateral femoral condyle to anterior tibia
PCL attaches
medial femoral condyle to posterior tibia
what is seen in wold-parkinson-white syndrome
antrioventricular conduction tract bypassing the atrioventricular node
how do you treat wolff- parkinson-white syndrome
procainmide- Na blocker
amiodarone- K channel blocker
will ectopic ACTH production from small cell lung cancer be suppressed with high dose dexamethasone administration
will high ACTH from a pituitary adenoma be suppressed with high dose dexamethasone
what is the mechanism of action of tamsulosin
alpha 1 selective
malassezia will cause...
a hypopigmented rash
what is the presentation of renal papillary necrosis
gross hematuria
acute flank pain
passage of tissue fragments in pee
high altitude exposure will result in what type of metabolic compensation
respiratory alkalosis
why do we get edema is nephrotic syndrome
we are peeing out protein, so there is less plasma oncotic pressure so there is an increase in plasma filtration in capillary bed
how do you treat C diphtheriae from order of importance
1. diphteria antitoxin
2. penicillin or erythromycin
3. DPT vaccine
how do you treat acute migraine
how do you prevent migraine
beta blocker
Ca blocker
how do you treat cluster headache
O2, ergotamine, sumatriptan
how do you prevent cluster headage
how you treat tension headache
what is the genetic issue with follicular lymphoma
what is the genetic issue with mantel cell lymphoma
what is the pentad of thrombotic thrombocytopenic purpura
1. neurological symptoms
2. renal symptoms
3. fever
4. thrombocytopenia
5. microangiopathic hemolytic anemia
what initiates transcription
CAAT box
TATA box
how do we get epispadias of penis
issue with genital tubercle
hepatocellular carcinoma is most strongly associated with which hepatitis
Hep B
what is the defect in hyper IgM syndrome
CDL on Th cell
what is the defect in chronic granulomatous disease
defect in NADPH oxidase
what will the nitroblue tetrazulium dye reduction test show in chronic granulomatous disease
fail to turn blue
what bug spreads chagas disease
what is budd chiari
thrmobosis or compression of hepatic vein with centrilobular congestion and necrosis
what are the potential cause of budd chiari
hypercoagulable, polycythemia vera, post partum state
what do fibrates inhibits and what does it activate
7-a- hydroxylase- inhibited

PPARa- activate
what do you want to give prior to surgury of pheochromocytoma
alpha antagonist followed by beta blocker
what is the target or rituximab
what are the lab findings the hemochromatosis
increase serum iron
increase ferritin
decrease transferriton
increase in transferin saturation
what does the parvoviris B 19 infect
erythrocyte precurosis
which group will have diarrhea with HUS- kids or adults
kids get diarrhea
which leukemia will have a dry tap on aspiration
hairy cell leukemia
what is the staining for hairy cell leukemia
positive TRAP
What is folinic acid also known as
how do you reverse toxicity of methotrexate
folinic acid aka leucovorin
what the congenital reasons for QT prolongation
mutation in K channel that delays
what is Romano Ward Syndrome
congenital long QT syndrome
What is Jervell and Lange-Nielsen syndrome
congenital long QT syndrome
sensorineural deafness
what is the mechanism of action of opiods
agonist at opiod receptor
open K channels and close Ca channels
what is in the marginal zone of a B cell lymphona
most outer part of the lymphome
contains memory B cell
what does opiods do for synaptic transmission
decrease in synaptic transmission
what do opiods inhibit the release of
Substance P
what is the excess collagen in keloid
collagen 3
what does collagen 3 make in terms of wound healing
granulation tissue
what does TGF beta cause in excess in wounds
keloid and hypertrophic scarring
TGF beta functions include
fibroblast migration, proliferation, and connective tissue synthesis
TGF beta can convert helper T cell to what type, what other factor does it need
TGF-beta and IL 6 to make Th17 cell
what is the first area to get damage by global cerebral ischemia
hippocampus- specifically the pyramidal cells
in general, what are the are the neurons to be worried in global cerebral ischemia
pyramidal cells of hippocampus and neocortex

purkinje cell of the cerebellum
where does positive selection happen in the thymus
where does negative selection happen in the thymus
what should be used to reduce chronic kidney disease in patients with hypertension and diabetes
what type of glands cause acne
sebaceous glands
what are the examples of holocrine glands
sebaceous glands
meibomian gland
what are the example of apocrine glands
mammary glands
what are the examples of merocrine glands
salivary gland
eccrine sweat glands
apocrine sweat glands
what is the mechanism of merocrine glands
cells secrete via exocytosis
what is the mechanism of apocrine glands
cells secrete via membrane bound vesciels
what is the mechanism of action of holocrine glands
cell lysis releases entire contents of the cytoplasm
what cells make glucagon
alpha cell of the pancreas
can you tell someone if a patient is stable if you cannot get their consent to do so
yes- only that they are stable
desmopressin can increase the levels of...
vWF from endothelial cell
factor 8
what are the signs of vitamin B 2 def aka riboflavin
inflammation of lips, fissures at corner of the mouth, corneal vascularization
what is riboflavin used for
redox reactions
what are the components of ribaflavin
what part of the cirtric acid cycle require FAD
succinate dehydrogenase to convert succinate to fumarate
when can we get a Hep D infection
with hep B
bipolar II will have...
hypomanic and depressive episode
bipolar I will have
at least one manic episode with or without a hypomanic or depressive episode
borderline personality disorder will have
unstable mood and relationships
erratic behavior
may have splitting
what are fetal hydrops
pleural effusion with secondary pulmonary hypoplasia, and ascites
what can parovirus B 19 present in adults
arthralgia aka joint pain
what is the function of Rb protein
prevents the damage cell from preceding G1 to S checkpoint via the inactivation of transcription factor E2F
when is Rb activated
hypophosphorylated- inactivates transcription factor E2F
when is Rb inactivated
what will happen if there is damage to lateral geniculate body
temporal hemiretina
what amino acid is needed for the excretion of acid
what happens when ATP binds to mosin
release of mysoin head from its binding site on the actin filament
what can be the result of increased urinary pressure on the kindey
renal parenchymal atrophy
what is the main muscle used in the valsalva maneuver
rectus abdominis
what will happen if there is injury to the meyer's loop in the temporal lobe
contralateral superior quadratanopia
what will be seen on blood smear of a babesiosis infection
intraerythrocyic organisms
what spreads babesiosis
ixodes tick
where is babesia infection hapen
northeastern US
what does an S4 sound mean
stiffness in ventricle wall
what does S3 sound mean
sudden cessation of passive ventricular filling
what do we called milder major depressive disorder lasting at least 2 year
persistent depressive disorder
alzheimer can happen with down syndrome because...
chromosome 21 has amyloid precursor protein
Alzheimer's disease involve in intracellular....
neurofibrillary tangles
Alzheimer's disease involve in extracellular....
AB amyloid beta plaque
AB amyloid plaques are...
abnormal fragments of amyloid precursor protein
neurofibrillary tangles compose of...
hyperphosphorylated tau protein
what happens when we have weight loss or a lot of exercise when it comes to periods
functional hypothalamic amenorrhea....results in loss of pulsatile GnRH
what is the mechanism of action of rifampins
inhibition of DNA- dependent RNA polymerase
what is the mechanism of action of isoniazid
inhibition of mycolic acid synthesis
what is the side effects of pyrazinamide
hepatotoxicity and hyperuricemia
what is the mechanism of action of ethambutol
inhibition of arabinosyl transferase
what is the most common presentation of cryptococcus neuformans
what are the withdrawl symptoms of heroin
dialated pupils, yarning, lacrimation
what are the withdrawal signs of stimulants
increased appetite
intense psychomotor reterdation
what is an imperforate hymen
incomplete degeneration of the central portion of the fibrous tissue band connection that walls of the vagina
what is the presentation of imperforate hyman
normal secondary sexual characteristics
cyclic abdominal or pelvic pain due to accumulate of periods blood
primary amenorrhea
where is angiotensin I converted to angiotensin II
small vessels of the lung
what causes isolated systolic hypertension
age related stiffness and decrease in compliance of the aorta and major peripheral arteries
both alleles contribute to the phenotype of the heterozygote
phenotype varies amount people of the same genotype
variable expressivity
what are examples of codominance
blood groups
a1- antritrypsin deficiency
what are the example of variable expressivity
NF 1 patients
not all people with a mutant genotype show the mutant phenotype
incomplete pentrance
what are examples of incomplete penetrance
BRAC1 gene mutation do not always get cancer
one gene contributes to multiple phenotypic effects
what is an example of pleiotropy
PKU- which results in light skin, intellectual disability, and musty oder
increased severity or earlier onset of disease in succeeding generations
patients inherits or develops a mutation in a tumor suppressor gene, the complementary allele must be deleted/mutated before cancer develops
loss of heterozygosity
what are examples of loss of heterozygosity
two hit hypothesis Lynch syndrome
Li-Fraumeni syndrome
a heterozygote produces a nonfunctional altered protein that also prevents the normal gene product from functioning
dominant negative mutation
tendency for certain alleles at 2 link loci to occur together more or less often than expected by chance
linkage disequilibrium
presence of genetically distinct cell lines in the same person
mutation at different loci produce a similar phenotype
locus hererogeneity
different mutations in the same locus produce the same phnotype
allelic heterogeneity
presence of normal and mutated mitochondrial DNA
what are an example of allelic heterogeneity
beta- thalassemia
what is the gene issue in beta thalassemia
beta gene on chromosome 11
gene mutation
what is the gene issue in alpha thalassemia
alpha gene on chromosome 16
gene deletion
what is an example of locus heterogeneity
achondroplasia chromsome affected
4- FGFR3
what is the inheritance for achondorplasia
what chromosome is affected in familial adenoamatous polyp
what is mutated in familial andenomatous polypsis
APC tumor suppressor gene
how do we get sporadic colorectal cancer
mutation in APC gene
what in the syndrome where a person is really friendly to stranger
williams syndrome
what are the facial feature of williams syndrome
elfin facies
what are the Ca issue in willaims syndrome
hypercalcemia due to increase sensitivity to vitamin D
what in the genetics behind williams syndrome
microdeletion of long arm of chromosome 7
what is the genetics behind cri-du-chat
microdeletion of short arm of chromosome 5
what 4 things cause activation of the intrinsic pathway
collagen, basement membrane, activated platelets, and high molecular weight kininogen/ kallikrein
what is the pathophysiology of myasthenia gravis
autoantibodies to posy synaptic ACh receptor
what is type II hypersensitvity
antibody bind to cell surface, result in cell destruction
what is type III hypersensitvity
antibody-antigen complex, activate complement and release neutrophil
what is type I hypersensitvity
anaphylactic shock, antigen cross link with IgE on presensitized mast cell, result in degranulation
what is type IV hypersenstivity
direct CD 8 kill or
CD 4 ID antigen and induce cytokine
what are the antibody against lambert- eaton myasthenic syndrome
autoantibodies to presynaptic Ca channel which decrease ACh release
what is the drug used to test for myasthenia gravis
edorphonoium- anticholinesterase increase ACh
how do you treat myasthenia gravis
pyridostigmine- anticholinesterase, increase ACh
what stool type is seen wiht acute mesenteric ischemia
currant jelly
what is the sign of chronic mesenteric ischemia
food aversion and weight loss
what artery is most affected in mesenteric ischemia
sarcoidosis presentation with x-ray presentation
shortness of breath
enlarged lymph nodes
immune mediated, widespread noncaseating granulomas
x-ray presentation will show bilateral adenopathy
what are the lab values for scaroidosis
elevated ACE
elevated CD4/CD8 ratio in bronchoalveolar lavage fluid
what are the calcium findings is sarcoidosis
hypercalcemia due to increase 1a hydroxylase mediated vitamin D activation in macrophages
what is the issue with osteopetrosis
failure of bone resorption due to defective osteoclast
what is the presentation of osteopetrosis
bone fractre, thrombocytopenia and leukopenia and anemia (due to bone taking up medullary space), vision and hearing issue due to skull being think impinge on nerve
why do we get osteopetrosis
mutations in carbonic anhydrase that impair osteoclast from generating acidic environment needed to reabsorb bone
what is the prophylaxis for osteoporosis- in terms of exercise
regular weight bearing exercise
what are AChE inhibitors used in alzhimers
what is mematine used for
what is the mechanism of action of metamine
NMDA receptors antagonist- reduce excitoxicity
what is clozapine used for
second generation antipsychotics
what are the first generation antipsychotics target
D2 antagonism
what is the mechanism of 2nd generation antipsychotics
D2 antagonist and blocks serotonin receptors
what symptoms can 1st generation anti-psychotics target
positive symtpoms
what symptoms can second generation anti psychotics target
positive and negative symptoms
why can 2nd generation antipsychotics cause drowsiness
block H1 receptors
what are metabolic issues associated with second generation antipsychotic
end in -pines
weight gain
what cardiac issue can 2nd generation antipsychotics cause
QT prolongation
what are the unique side effect of clozapine
agranyloytosis- monitor WBC regularly
what is the unique side effect of resperidone
prolactinemia- due to blockaged of D2 inhibition
what is a endocrine side effect 1st gen antipsychotics
hypeprolactinemia due to dopamine receptor antgonism
what medication will we see neuroleptic malignant sydrome and tardive dyskinesia
first generation anti-psychotics
why do we see tardive dyskinesia
after chronic use of 1st generation antupsychotics
what is the MOA of trazadone
blocks 5-HT2, a1- adrenergic, H1 receptors
what is the MOA of bupropion
increase in NE and dropmine
what is bupropion used for
smoking cessation
what is the MOA of varenicline
nicotinic ACh receptor partial agonist
what is the varenicline used for
smoking cessation
weaken the rewarding the effect of nicotine
what is secreted in response to hypoglycemia
what is the effect of glucagon
stimulate hepatic glucose production
why does hyperammonemia result in coma
cerebral edema
what is the equation for flow rate
Q- flow rate
V- velocity
A- cross sectional area
what is the difference between costrochondritis and pleuirsy
costrochondritis will have pain with palpation of chest-hurts when there is pressure between the rib and cartilage
what is the first step in intracellular killing
create radical oxygen with NADPH oxidase
what is the stages of O2 dependent killed
O2 converted to O2- via NADPH oxidase
O2- converted to H2O2 via superoxide dumitase
H2O2 converted to HOCl radical via myeloperoxidase
HOCl will then destroy phagosome
what will damage in the posterior communicating artery result in
blown out pupil, down and out eye
due to damage to CN III
how do we treat salmonella typhi
ceftriaxone or fluoroquinolone
what is the time criteria for brief psychotic disorder
less than 1 month
will have delusions, hallucination, ect
what is the time criteria for schizophreniform disorder
1-6 months
will have delusions, hallucination, ect
what is the time criteria for schizoaffective disorder
more than 2 weeks without major mood episode
will have delusions, hallucination, ect
PLUS periods of concurrent major mood episode
what is clonidine
a2 agonist
what is guanfacine
a2 agonist
what is clonidine/ guanfacine used for
hypertensive urgency, ADHD, tourette syndrome
what is phenoxybenzamine
irreversible alpha 1 blocker
what is VIPoma, what are the action of VIP
non alpha and non beta islet cell pancreatic tumor

increase intestinal water and electrolyte secretion and increase relaxaion of intestinal smooth muscle and spincters
what is the signs of VIPoma
watery diarrhea, hypokalemia, low secretion of acid
what do we think a patient has if they have buring abdominal pain that does not get that much better with PPI
gastrinoma, zollinger ellison syndrome
what is the presentation of a patient with tuberous sclerosis
hamartomas in CNS and skin
ash leaf spot
cardiac rhabdomyoma- most common primary cardiac tumor in children
renal angiomylopoma
shagreen patchines
increase incidence of subependymal astrocytoma
what is the presentation of neurofibromatosis 1
cafe au lait spot
lisch nodules
cutaneous neurofibroma
optic gliomas
what are some biological agents that can be used to treat RA
TNF-a inhibitors
what intestinal nematode aka round worn is associated with respiratory symptoms
ascaris lumbricoides
what ligament has to be cut to get to the spinal cord
ligamentum flavum
what will be seen on gram stain of candida
peseudohypea- yeast form
in the cold
what will canidida show in the heat
germ tubes
what is dead space
area that is ventilated but not perfused
what is the presentation of IgA nephropathy
episodic gross hematuria that occurs concurrently with respiratory of GI tract infections
what is the presentation of acute interstitial nephritis
CV tenderness
what is the cause of acute interstitial nephritis
after getting drugs
what cancer is associated with lambert-easton myasthenic syndrome
small cell lung cancer
the central retinal artery is a branch of....
opthalmic artery
how do we cool down the body
exaporation of sweat
what is the pathology of polyarteritis nodosa
transmural inflammation of the arterial wall and fibrinoid necrosis
segmental ischemic necrosis
why do we not want to mix alcohol with acetaminophen
.Alcohol induces the synthesis of CYP2E1 isoenzyme aka a cytochrome p450 enzymes, causing a higher percentage of acetaminophen to be converted to NAPQ1
what happens to LH:FSH and fasting insulin in PCOS
things from this place will be sent to the golgi apparatus
endoplasmic reticulum
what is the function of COPI
golgi to golgi- retrograde
back aka cis of golgi to endoplasmic reticulum
what is the function of COPII
endoplasmic reticulum to back aka cis golgi
what is the function of clatherin
trans-golgi to lysosome
plasma membrane to endosome
what is the histology of small cell lung cancer
small dark blue cell
positive chromogranin
neuron-specific enolase positive aka neural cell adhesion molecule
what can be made from small cell lung cancer
Antibodies against presynaptic Ca channels
what is the presentation of klinefeler syndrome
testicular atrophy
eunuchoid body shape
what is the patho-physiology of klinefelter syndrome
dysgenesis of seminiferous tubule- results in low inhibin B- which cause an increase FSH

abnormal leydig cell function- which cause decrease in testosterone, increase LH, increase estrogen
what is the treatment in atropine overdose
physostigmine- anticholinesterases increase ACh
what is transformation
ability for bacteria to take up naked DNA from environment
will not work if DNase is present
what will be seen in chronic inflammation
mononuclear cell like macrophages, lymphocytes , plasma cell
fibroblast mediated and collagen deposition
what will be seen in granuloma formation
epithelioid macrophage and giant cell
where do we secrete EPO from
what is the function of vitamin E
antioxidant, protect RBC and membrane from free radical damage
what vitamin def can have neurologic presentation similar to vitamine B12 def wihtout the megaolblastic anemia, hypersegmented neutrophils, and increase in serum methlymalonic acid
vitamin E
what does CN V1 and V2 exit out of
foramen rotundum
what does CN V3 exit out of
foramen ovale
what comes out of the internal auditory meatus
CN 7 and 8
what comes out of the foramen spinosum
middle meningeal artery
what is damaged in epidural hematoma
middle meningeal artery
what will be seen on CT of epidural hematoma
lens pool of blood
does not cross suture lines
does subdural hematoma cross suture lines
what is wrong with subdural hematoma
rupture of bridging vein
what is the signs of syringomyelia
sensory loos of pain and temperature
fine touch and position is spared
what is the pathophysiology of syringomyelia
cystic cavity aka syrinx within central canal of spinal cords
damage to anterior white commissure
what thing is at risk of getting injured in removal of protate
pelvic parasympathetic nerves
prostatic plexus
what is sildenafil
inhibit PDG5, increase cGMP, increase NO and prolong smooth muscle relaxation
what is the presentation of goodpasture
coughing up blood
issue breathing
pretty much renal and lung issue
what will be seen on IF of goodpasture
linear IF
what parts of the kindey are most susceptible to renal ischemia
PCT and thick ascending limb
what happens to the lungs after we smoking
mucus production and secretion go up
activity of airway cilia go down
alveolar macrophages function go down
what does the left circumflex artery come off of
left main coronary artery
what is the cause of albinism
decrease in melanin production due to decrease in tyrosinase activity or defective tyrosine transport
what is the gene affected in Li-Fraumeni syndrome
what is the gene product of TP53, what does it do
p53, activates p21 which blocks G1 to S phase
what is the sign of rupture of intervertebral disc
pain that radiates after lifting something heavy
what is the metabolite of morphine, is it active
morphine-6-glucuronide, it is active and more potent than morphine
why do we get issues with morphine ADR when we take too much
morphine is metabolized to more potent metabolites aka morphine-6-glucuronide that accumulates in the body
what muscle in the rotator cuff lateral rotate arm
teres minor and intraspinatus
what muscle in the rotator cuff medially rotates arm
what muscle in the rotator cuff initially abducts the arm
what is the strongest risk factor for pancreatic adenocarcinoma
what is delusional disorder
fixed, persistent, false belief system lasting more than 1 month
what is the lysosomes
digestion of cellular debris and pathogens
what is peroxisomes
oxidation of very long and branched chain fatty acids
hydrogen peroxide degeneration
what is proteasomes
degradation of ubiquitinated proteins
what is the function of rough endoplasmic reticulum
synthesis of integral membrane and secretory proteins
what is the function of smooth endoplasmic reticulum
drug detoxification
lipid, phospholipid, and steroid synthesis
what is the equation for filtration fraction
filtration fraction = Glomerular filtration rate/Renal plasma flow
what is the equation for renal plasma flow
renal plasma flow= renal blood flow * (1-hematocrit)
what microbe should you be worried about if CD4 is below 200
pneumocystis jirovecii
what microbe should you be worried about if CD4 is below 100
toxoplasma gondii
what microbe should you be worried about if CD4 is below 50
mycobacterium avium
what microbe should you be worried about if CD4 is below 150
histoplasma capsulatum
how do you treat pneumocystis jirovecii
how do you treat toxoplasma gondii
trimethoprim sulfamethoxazole
how do you treat mycobacterium avium
how do you treat histoplasma capsulatum
what presents with a palpable abdominal mass- aortic abdominal aneurysm or aortic dissection
aortic abdominal aneurysm
what causes aortic aneurysm
chronic transmural inflammation
what type of emphysema does alpha 1- antitrypsin deficiency happen
panacinar emphysema
what does steroids do to the liver
increase in hepatic gluconeogenesis and glycogenesis
why do we have stria with steroids
inhibition of fibroblast proliferation and collagen formation in skin- results in thinking of skin aka stria and impaired wound healing
what does nonbacterial thrombotic endocarditis indicate
nonbacterial thrombotic endocarditis- deposition of sterile platelet thrombi on cardiac valves
seen with advanced malignancy and chronic inflammatory disorders such as antiphospholipid syndrome, systemic lupus erythematosus
what type of lymphadenopathy does a lesion in the medial lower extremity cause
inguinal lymphadenopathy
what type of lymphadenopathy does a lesion in the lateral lower extremity cause
popliteal and inguinal lymphadenopathy
what is seen in bacterial endocarditis
roth spots- on retina
osler nodes- painful
janeway lesions- painless
nail-bed hemorrhage
what is the pathogenesis of osler nodes
seen in bacterial endocarditis
immune complex deposition in skin
what is the pathogenesis of janeway lesions
microemboli to skin vessels
what is myasthenia gravis associated with
thymoma and thymic hyperplasia
what is made by the 3rd pharyngeal pouch
thymus and inferior parathyroid gland
where is ADH made
in the paraventricular and supraoptic nuclei of the hypothalamus
what is the first sign of alcohol withdrawl
anxiety, insomnia, tremors, diaphoresis aka sweating a lot, GI upset
happen 6-24 hours after last drink
when do we get seizures in alcohol withdrawl
12-48 hours after last drink
what are delirium tremens
happens with alcohol withdrawal
confusion, agitation, fever, tachycardia, hypertension, sweating, hallucinations
when do delirum tremens after last drink
48-96 hours
what type of antibiotics have a MOA of interfering in aminoacyl-tRNA binding
what antibiotic has a mechanism of action of binding to the 23S rRNA of the 50S ribsomal subunit and block translocation
macrolides and clindamycin
how do macrolides work
bind to 50S ribosomal subunit- block translocation
what is the presentation of mucoymycosis and rhizopus
seen in diabetic ketoacidosis
necrotic eschar on face
possible nerve injury
penetrate brain via cribriform plate
what are the steps for base excision repair
glcosylase cleaves the altered base
endonuclease cleaves the 5' end and lyase cleaves the 3' sugar phosphate
DNA polymerase fills the single nucleotide gap and ligase seals the nick
what is the function of glycosylase
cleaves the altered base
what is the function of endonuclease
cleaves the 5' end of damaged DNA
what is the function of lyase
cleaves the 3' sugar phosphate
what is the function of ligase
seals the nick on DNA
what will be seen on electromyograhy in a patient with clostridium botulinum
decrease in muscle response following stimulation of a motor nerve
what is the pathophysiology of C. botulism
produce a heat labile toxin that inhibits ACh release in the neuromuscular function
what endometrial process cause menstration
what is the MOA of a rash after taking a drug
minus beta lactam and sulfonamide
IgE independent mast cell activation
how does IgE independent mast cell activation degranulate
via activation of protein kinase A and PI3 kinase
what does angiotensin II cause to arteries
what supplies blood to the proximal ureter
renal artery
what supplies blood to the distal ureter
superior vesical artery
what is the MOA to an axillary nerve injury
anterior humerus dislocation
what is damages in a spinal fracture of the midshaft humerus
radial nerve
what is seen in acute respiratory distress syndrome
endothelial damage which results in increase alveolar capillary permeability which result in protien rich leakage into the alveoli which reuslt in diffuse alveolar damage
what is the function of thrombin
convert fibrinogen to fibrin
what is needed in bacterial cell wall synthesis
what is the enzyme needed for peptidoglycan synthesis that will result in a bacterial cell wall
which bacteria lack a cell wall
mycoplasma bacteria
what is the presentation of inflammatory breast cancer
dermal lymphatic invasion by breast carcinoma
breast look like orange pell
what is the pathophysiology of inflammatory breast cancer
neoplastic cells block lymphatic drainage
what will be seen in selective IgA def
airway and GI infections
autoimmune disease
anaphylaxis to IgA containing products such as in blood products
what part of the urethra is most commonly damaged in pelvic fracture
membranous urethra
what part of the urethra is damaged in straddle injuries
penile and bulbous segment of the urethra
what eye condition is very painful
acute closure glaucoma
what medication can precipitate acute closed angle glaucoma
what does heme oxygenase do
converts heme to biliverdin
what causes a bruise to have color
what will aortic regurg result in
left ventricular dilation and eccentric hypertrophy
will result in increase stroke volume
what is the light microscopy of acute poststreptococcal glomerulonephritis
glomeruli enlarged and hypercellular
what is the IF in acute poststreptococcal glomerulonephritis
granular appearance due to IgG, IgM, and C3 deposition along glomurular basement membrane
why do we get graves ophthalmopathy
immune mediated, activated T cells increase fibroblast secretion
result in excess amount of glycosaminoglycans
what is the MOA of graves
thyroid stimulating immunoglobulin IgG stimulates TSH receptors
what is the triad for fat emboli PE
hypoxemia, neurological abnormalities, petechial rash
what will be normal in ARDS
pulmonary capillary wedge pressure
what is the presentation of hyperadosteronism
hypertension hypokalemia, and metabolic alkalosis
why do we not see high sodium in hyperaldosteronism
aldosterone escape
the increased intravascular volume caused increased renal blood flow and therefore more natriuresis and loss of sodium
chancroid is a...
deep painful ulcer with raged borders that are associated with a grey exudate and inguinal lymphadenopathy
what is the microorganism that cause chancroid
haemophilius ducreyi
what does the mullerian/ paramesonephic duct make
female internal structures and part of upper vagina
pharmacokinetic formula for half life
Vd x 0.7 / clearance
pharmacokinetic formula for maintenance dose
steady state plasma concentration x clearance / bioavaliability factor
pharmacokinetic formula for loading dose
steady state plasma concentration x volume of distribution / bioavailability fraction
what is seen with phenotypic mixing
host cell has 2 viral strains
the virus will have nucleocapsid protein from one strain and unchanged parental genome from the other strain
will the next generation in phenotypic mixed virus revert back to the original
yes- because the underlying viral genome was not changed
what is the first line medication for ADHD
stimulant drugs that increase the availability of norepinephrine and dopmaine
what are the stimulant drugs used in ADHD
methlypheidate, dextroamphetamine, methamphetamine
what is associated with polyhydramnios
gastrointestinal obstruction and anencephaly
does nitroprusside affect stroke volume
what is a glomangioma
tender, small red blue lesion under the nail bed
what is the origination of glomangioma
modified smooth muscle cells that control thermoregulatory function
what blood supply is posteromedial papillary muscle supplied by
posterior descending
what does the glossopharyngeal nerve provide to the tounge
posterior 1/3 taste and sense
what nerve supplies sensation to the tonsillar lining
glossopharyngeal nerve
what gland does the glossopharyngeal nerve supply
parotid gland secretion
what provides sensation to the anterior 2/3 of tounge
what provides taste to the anterior 2/3 of tounge
what is the typical presentation of primary biliary cirrhosis
fatigue and pruritus in a middle age women
what is the typical presentation of a patient with primary sclerosing cholangitis
middle age man with IBD
elevated alk phos
what is the ophthalmic artery a branch of
internal carotid artery
why do we get guillian barre syndrome
molecular mimicry, antibodies formed against infectious agents cross react with myelin and schwann cell
what can be a measurement for renal plasma flow
PAH clearance
what can Vit A def cause
keratinizing epithelium
what is the function of Vit A
maintain mucus secreting columnar epithelia of the ocular conjunctiva, respiratory and urinary tract, and pancreatic and other exocrine duct
when will we see wide and fixed S2 splitting
what is mifepristone
progesterone antagonist
glucocorticoid antagonist
what is misoprostol
prostaglandin E1 agonist
what will damage to the lower trunk of the brachial plexus result in
damage to median and ulnar nerve
where does isotype switching in the B cells happen
germinal center
when does insulin peak once injected
2-4 hours after
what pathway do antipshycotics target
tuberoinfundibular pathway
mesocorticol pathway
mesolimbic pathway
nigrostrial pathway
what does decrease activity in the mesocorticol pathway result in
negative symptoms, flat affected and limited speech
what does increase activity in the mesolimbic pathway result in
positive symptoms, delusions and hallucinations
what does decrease activity in the nigrostrial pathway result in
extrapyramidal symptoms- parkinsonism, tardive dyskinesia, dystonia
what does decrease activity in the tuberinfundibular pathway result in
increase prolaction
what does buprenorphine target
partial opioid receptor agonist that binds with high affinity but has low instrinsic activity
what can buprenorphine do in patients on long term opioid therapy
precipitate withdrawl
what is a partial agonist
act at same sight as full agonist but has lower maximal effect
what does a noncompetitive antagonist do
decrease efficacy by shifting curve down
cannot be overcome by increase agonist substrate concentration
what does a competitive antagonist do
shift curve to the right and decrease potency
can be overcome by increasing the concentration of agonist substrate
what are the findings in uremic platelet dysfunction
normal PT, PTT, platelet count
increase bleeding time
what are the signs of marijuana intoxication
conjunctival injection, tachycardia, increased appetite, and dry mouth
what are the first line medications for bipolar
lithium, valproate, 2nd generation quetiapine
how can you calculate cardiac output with the fink principle
rate of consumption/ arteriovenous O2 content difference
what is the issue with systemic primary carnitine deficincy
inherited defect in the transport of long chain fatty acids into the mitochondria
what is the result of systemic primary carnitine deficiency
weakness, hypotonia, hypoketotic hypoglycemia
what is needed for the infection of shigella
mucosal infection of the M cell that overlie Peyer's patch
what are the non lactose fermenting organism
what muscle is at the anterior midaxillary line of the chest
serratus anterior
what does a chest tube go through for pleural effision at the midaxillary line
serratus anterior muscle, intercostal muscle, ad parietal pleura
what is the presentation of gaucher disease
lipid laden macrophages resembling crumpled tissue/lipid laden macrophages
bone crisis
what is the enzyme deficient in gaucher disease
what neuro tracts are affected in vitamin B 12 def
spinocerebellar tracts
lateral corticospinal tracts
dorsal column
how does neisseria meningitidis transfered
pharynx to blood to choroid plexus to meninges
what creates a pearly substance in the ear and has conductive hearing loss
what is the treatment for fructose intolerance
deficiency of aldolase B
decrease intake in fructose and sucrose
sucrose is glucose and fructose
what is choesteatoma in the ear due to
squamous cell debris, overgrowth of desquamated keratin debris within the middle ear space
what is the enzyme is affected in galactokinase deficncy
defect in galacotokinase
what is the mechanism of action of amphotericin B and nystatin
bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis
what is the mechanism if action of azole
inhibit the synthesis of ergosterol
what is congenital torticollis
child prefers to hold head tilted to one side
what is the common cause of congenital torticollis
malposition of the head in utero
what does tropheryma wipplei cuase
whipple disease
what is the pathology of whipple disease
PAS positive foamey macrophage in intestinal lamina propria
what are the symptoms of whipple disease
fat malabsorption, cardiac symptoms, arthalgias which affects the joint and lymph node, neurological symptoms
what is abetalipoproteinemia
inherited inability to make apolipoprotein B
lipids accumulate in the small intestine
what brain cancer will have rosenthal fiber
pilocytic astrocytoma
what will be seen in ependymomas
hydrocephalus because the enendymal cell in 4th ventricle is affected
at what level do we do a lumbar puncture
L3/L4 or L4/L5
at what level of the iliac crest
L4 verebral body
what are the signs of pheochromocytoms
paraoxysamal hypertension, flushing, diaphoresis, and headache
what happens to our lungs as we age
TLC unchange
FRV decreased
RV increased
what do we see with crohn disease with ileal resection
bile acid malabsorption
cannot absorb fat soluble vitamins
cannot get Vit K- impaired coagulation
where is the issue in broca aphasia
where is the SA node location
junction of the right atrium and superior vena cava
what antifungal targets the cell wall
where is the edinger-westhphal nuclei located
upper midbrain
how do youtreat drug induced parkinsonism
muscarinic antagonist- benztropine
what is the issue with galactose deficiency
issue with galactokinase
what are the symptoms of glactokinase deficiency
glalactose in blood, infantile cataracts
what are signs of iron def anemia
spoon shape nails aka koilonychia
shiny red tounge
what is the triad for pulmmer vinson syndrome
esophageal web
iron deficiency anemia
how can direct arteriolar vasodilator lower blood pressure but have tachycardia
activation of sympathetic activity
how can direct arteriolar vasodulator lower blood pressure but have edema
activation of RAAS
What is fidaxomicin
macrocyclic antibody that inhibit RNA polymerase
used against C. diff
what breast cancer will have microcalcidications
ductal carcinoma in situ
what happens to the heart as we age
decrease in left ventricular chamber apex to base
development of sigmoid shaped ventricular septum
myocardial atrophy with increased collagen deposition
accumulation of cytoplasmic lipofuscion pigments
what is the different in first and second fever in Dengue virus
first is usually self limited and the secondary infection is due to a different viral serotype that cause a more severe illness
what is the genetics behind hypertrophic cardiomyopathy
beta myosin heavy chain mutation
what is the pathology of papillary thyroid crcinma
large cell with finely dispersed chromatin- results in an empty or ground glass appearance
intranuclear inclusions or grooves
what is the pathology of follicular carcinoma
malignant proliferation of follicules surrounded by a fibrous capsule with invasion through capsule
what is the genetics behind heritable pulmonary arterial hypertension
what is the function of BMPR2
inhibits vascular smooth muscle proliferation
what is affected in RTA type I
defect in ability of alpha intercalated cell to secrete H
what is urine pH and K level in RTA type I
urine pH greater than 5.5
what is affected in RTA type II
defect in proximal convoluted tubule HCO3- re-absorption
what is the pH and K level in RTA type II
urine pH less than 5.5
what is affected in RTA type 4
what is the pH and K level in RTA type 4
urine pH less than 5.5
what is seen with angiomyolipoma
tuberous scelerosis
can we see paraneoplasic syndrome in renal cell carcinoma
ectopic EPO, ATCH, PTHrP, renin
what can schistosoma haematpobium cause
squamous cell carcinoma of the bladder
what is seen in patau syndrome
cleft lip/ palate
cutis aplasia
where does trigeminal nerve originate from
middle cerebellar peduncle at the lateral aspect of the mid pons
what is the treatment for gardnerella vaginalis
clindamycin and metroidazole
how do we reverse cholinesterase inhibitor activity aka cholinergic activity is high
antimuscarinic agent
glycopyrrolate, hyoscyamine, propantheline
what is the presentation of reseola
fever for 3-5 days followed by truncal rash
most common cause of febrile seizures
what supplies cutaneous innervation below dentate line
inferior rectal nerve- branch of pudendal nerve
why do we get calcified heart valves
because the cells were necrosis
what is raloxifene activity on breast, bone, uterus
estrogen antagonist effect at breast
estrogen agonist at bone
estrogen antagonist at uterus
what is tamoxifen activity on breast, bone, uterus
estrogen antagonist for breast
estrogen agonist at bone
estrogen agonist at uterus
what is isoproterenol
beta 1 and 2 adrenergic receptor agonist
what do you give to someone who ate rat poison
fresh frozen plasma
how do you treat heparin overdose
protamine sulfate
what is as effective as asprin in the prevention of CV event sin those with coronary heart disease
what is the MOA of clopidogrel
irreversibly block P2Y component of ADP receptor on the platelet surface and prevents platelet aggregation
what is first time in the treatment of lyme disease
what is the deficient enzyme in pompe disease
acid a-glucosidase
what is the clinical picture of pompe disease
a-glucosidase def
muscular hypotonia
abnormal glycogen accumulation within lysosomal vesicles
what can be damaged in prolong exposure to loud noise
organ of corti
what is the genetic behind medullary thyroid carcinoma
what are the clinical findings in lactose intolerance
increase hydrogen content
reduced stool pH
elevated stool osmolality
what antidepressant can cause a long erection
what will be seen on microscopic evaluation of Creutzfeldt Jacob
multiple vacuoles are seen in the gray matter of the brain
what is the function of PD-1
programmed death receptor which downregulates the immune response against tumor cells by inhibiting cytotoxic T cells
what inhibits fatty acid degradation
malonyl CoA
how is trypsin activated from trypsinogen
duodenal brush border enteropeptidase
what is the function of trypsin
activates other pancreatic enzymes
degrade polypeptides
where is proinsulin cleaved into insulin and C peptide
secretory granules
what does intestinal bacteria cause an increase growth in
vitamin K and folic
what is the mechanism of action of thiazolidinediones
increase activity in a transcriptional regulator of genes
peroxisome proliferator activated receptor-y
what is the presentation of tay sachs disease
cherry red spot on macula
progressive neurodegeration
lysosomes with onions skin
NO hepatosplenomegaly
what is the enzyme issue with tay sachs
hexosaminidase A
what is built up in tay sachs
GM2 ganglioside
what will be seen in myotonic dystrophy
issue relaxing muscle
muscle wasting
frontal balding
testicular atrophy
what is the defect in myotonic dystrophy
CGT trinucleotide repeat and expansion in DMPK
what is the most common cause of aortic stenosis in the US
bicuspid aortic valve
what is the destruction in pernicious anemia
CD4 cell mediated destruction of parietal cell
what does the transverse spinal cord look like
interomediolateral cell column will be present
at what level of the spinal cord is gracile and cuneate fasciculi present
above the T7 spinal cord

only gracile below T7
what should you consider for those with severe asthma
omalizumab- anti-IgE antibodies
how do alpha adrenergic agonist help with glaucoma
inhibit production of aqueous humor due to vasocontriction
how do beta blockers help with glaucoma
decrease production of aqueous humor
how do prostaglandins help with glaucoma
increase outflow of aqueous liquid
uveoscleral outflow
what is the mechanism behind a false diverticula
pulsion due to strained bowel movement
what would be a description of someone with schizoid
voluntary social withdrawl, happy being alone, limited emotional expression
what would be the description of someone who is schizotypal
eccentric appearance, odd belief, interpersonal awkwardness
what is the pathophysiology of v cholerae
does not invade muscoa, cholera toxin activate adenylate cyclase causing Cl efflux and decreased Na reabsorption
what artery run along the lesser curvature of the stomach
gastric arteries
what will be seen in severe hypertesion in retinal precapillary arterioles
flame shaped hemorrhage
what do cardinal vein give rise to
superior vena cava
what initiates atherosclerosis
endothelial cell injury
what do sertoli cells secrete when stimulated by FSH
inhibin B
patients with mild/tuberculoid leprosy will display what type of immune response
TH1 mediated- IL2, INF-y, IL-12
patients with severe/ lepromatous leprosy will display what type of immune response
TH2 mediated- IL4, IL5, 1L10
where is lymphatic drainage of the rectum proximal to the anal dentate line
inferior mesenteric and internal iliac lymph nodes
where is lympathic drainage of the rectum distal to the anal dectate line
inguinal nodes
what is a specific test that can be done in acute cholecystitis
radionuclide biliary scan
what will be seen in charcot bouchard- what makes it different from hypertensive arteriolar sclerosis
lacunar stroke
intraparenchymal hemorrhage- how we can differentiate this lacunar infart from hypertensive arteriolar sclerosis
what will be seen in sporothrix schnckii
nodules that spread along lymphatics
what will increase the murmur in hypertrophic cardiomypathy
standing up- decreases preload
this will decrease sound of all other types of murmur
what will be built up in methotraxate
what do we need to prevent superfical candida infection
Th cells
what do we need to prevent hematogenous candida infection
what are the complication of MI from day 3-14
free wall rupture- cardiac tamponade
papillary muscle rupture- mitral regurg
interventricular septal rupture
what is a fatal complication of digoxin
what cestode/ tapeworm can cause anaphylactic shock if the cyst are ruptured
echinococcus granulosus
what glands do CN 7 innervate
parasympathetic innervation to lacrimal, submandibular, and sublingual salivary gland
what is the presentation of zollinger ellison syndrome
peptic ulcer
acid reflux
where is the ureter in the true pelvis in relation to internal iliac artery and ovarian vessel
anterior to internal iliac artery and medial to the ovarian vessel
what do the ureter pass through to reach the true pelvis
anterior to the common/ external iliac arteries
posterior to the ovarian/ gonadal vessel
what do doxotubicin and daunorubin result in
dialated cardiomyopathy

give dexrazoxane- an iron chelating agent to reduce this progression
what innervates the parotid gland and help with salivation
what is attrition bias
a type of selection bias- happens when there is a disproportionate loss to follow up between the two groups
what is the genetic defect in fragile X
CGG trinucleotide repeat
X link dominant
what are the findings for fragile X syndrome
macroecephaly, long narrow face, prominent forehead, jaw, chin, and ears
what should be used in prophylactics for neisseria meningitis
where is pulmonary vascular resistance lowest
functional residual capacity
why does increased lung volume increase pulmonary vascular resistance
longitudinal stretching of alveolar capillaries via expanding alveoli
why does decrease lung volume increase pulmonary vascular resistance
decreased radial traction from adjacent tissue
pulm vessels will collapse around the alveoli
what are the intracellular ions
what are the extracellular ions
Na Cl Ca
what is the most common type of injury in traumatic aortic rupture
aortic isthmus
what are the beta lactamase inhibitors
clavulanic acid
what is unique about viral CSF findings
normal sugar
what in unique about bacterial CSF findings
increase PMN
what is unique about fungi CSF findings
increased lymphocytes AND decrease sugar
what is the most common cause of viral meningitis
enterovirus- a type of picornaviridae
what is the diagnosis for HSV encephalitis
temporal lob hemorrhage/ edema in brain imaging
detect HSV on cerebral spinal fluid
how do we diagnosis mucormycosis
histological examination of affected tissue
what is the pathophysiology of TTP
inhibition or def. of ADAMTS 13 therefore decrease degradation of of vWF multimers
what biochem reactions need NAD
dehydrogenase and reductase reaction
why is acyclovir good for HSV and VZV and not EBV or CMV
HSV and VZV has a virally encoded thymidine kinase which activate acyclovir. EBV or CMV do not have the same thymidine kinase
what test the biceps reflex
what test the triceps reflex
what causes duodenal ulcer
H. pylori
where does hydroxylation of collagen happen
what is the function of anterior hypothalamus
cooling and parasympathetic
what is the function of posterior hypothalamus
heating and sympathetic
what happens to balance between foward flow and regurg flow when we decrease systemic vascular resistance
increase forward flow
what are the symptoms of carpal tunnel
sensory issue in median nerve
thenar atrophy
what is affected in lateral ankle sprain
talofibular ligament
what is the presentation of chronic lung transplant rejection
bronchiolitis obliterans
what cause superior glutreal nerve injury
inject into upper medial gluteal region
what is somatic symptom disorder
body complaints without being sick
how do you treat somatic symptom disorder
regular appointment
what is the major virulence factor of haemophilus influenzae
polyribosylribitol phosphate on the capsule
what is a normal Aa gradient
what does the cricithyrotomy pass through
superfical cervical fasica, pretracheal fascia, and cricothyroid membrane
what will happen to bone when there is high PTH
subperiosteal resorption with cystic degeneration
osteitis fibrosa cystic- cystic bone space with brown fibrous tissue
when do we see osteitis fibrosa cystica, what is its cause
primary hyperparathyroidism
cystic bone spaces filled with brown fibrous tissue
osteoclast and deposited hemosiderin from hemorrhage
what does hep B have that is needed for replication
RNA- dependent DNA-polymerase activity
contained a partially double stranded circular DNA
what mediates the cough reflex
internal laryngeal nerve at the piriform recess
what is the issue with hemochromatosis
AR mutation in HFE gene
increased intestinal absorption due to abnrormal iron sensing
how do you tell between relative and absolute erythrocytosis aka polycythemia
red blood cell mass. normal means relative
what is needed for the fusion and release of neurotransmitter vesicles into the synaptic cleft
voltage gated Ca channel
where do anesthetics redistribute to
tissue with relatively low blood flow- skeletal muscle, fat, bone
does mycoplasma pneumonia gram stain
in term of catheter UTI what is the best way to reduce them
remove the catheter when no longer needed
why does Hep B cause heaptocellular carcinoma
integration of viral DNA into the genome of host hepatocytes triggers neoplastic change
when is alpha fetoprotein marker low in normal pregnancy
first trimester
most etiologies of birth have increased AFP, what would have decreased
what will happen to the baby's glucose if born to a mom with high blood sugar
hypoglycemia due to the increased insulin
what can be the result of west nile virus
asymmetric flaccid paralysis, parkinsonian features, encephalitis
what is the obstacle for the horse shoe kidney to rise
what is the cause of caludication
artherosclerosis- lipid filled intimal plaque
what is on the 3- end of RNA
poly A tail
what is on the 3' end of tRNA
CCA tail- where amino acid binds
what is on the 5' end of RNA
methylguanosine cap
what will happen in ricckets
excess unmineralized osteoid matrix
what is seen in superior vena cava syndrome
swelling of face and neck
what is superior vena cava syndrome due to
mediastinal mass
what is the other name for pancoast tumor
superior sulcus tumor
what is actinic keratosis a precursor of
squamous cell carcinoma
what is the anti-Rh immune globulin given in pregnancy
IgG- given to a Rh negative mom and Rh positive kid to prevent further pregnancies from getting attacked my mom antibodies
what is the cause of secondary bacterial pneumonia following an influenza infection in a young person
S. aureus
what happens with acute salicylate intoxication within the first 12 hours
respiratory alkalosis
what happens to acute salicylate intoxication after 12 hours
anion gap metabolic acidosis
what is cheyne stokes breathing and when do we see it
seen in patients with CHF
cyclic breathing
what causes staphylococcal scalded skin syndrome
exotoxin mediated skin damage
how do cancer cells increase drug resistance
via the MDR1 gene which encodes for P-glycoprotein which is a transmembrane ATP- dependent efflux pump protein
what does the reaction dihydrobiopterin reductase result in
convert phenlylalanine to tyrosine and tyrosine to DOPA
what does ionizing radiation do
double strand breakage
free radical formation
what joints are involved in ankylosis spondylitis
bilateral sarcoiliac joints
how do you measure the severity of ankylosing spondylitis
degree of chest expansion
which HLA is associated with ankylosing spondylitis
what can happen with a lot of aldosterone
low K- paresthesias and muscle weakness
how do you tell the difference between leukomoid reaction and CML
both have increased WBC but CML has decrease alkaline phosphatase
what are 5 complications of varicose veins
skin ulcerations
wound healing
chronic edema
stasis dermatitis
what drugs end in -tilide
class 3 anti-arrhythmic
what is seen with a scaly plaque
actinic keratosis
where can gluconeogenesis happen
liver, kidney, intestinal epithelium
when do we close the neural tube
week 4
when in gestation do the fetus have male/ female characterisitcis
week 10
when do we get the bilaminar plate in gestation
week 2
when do we get form the notocord
week 3
when do we form the trilaminar embryonic disc
week 3
what does the monospot test entail
heterophile antibodies IgM detected by agglutination of sheep or horse RBC
what antibodies are used in the monospot test
what do atrial natriuretic peptide respond do
increase blood volume
what is the next step once you find a third degree heart block
what is the definition of precontemplation
person is not intending to take action in future and does not see their behavior as problematic
what is the definition of contemplation
person recognize their behavior is problematic, and they are looking at the pros and cons of continuing what they are doing
what is the definition of preparation
people are intending to take action in the immediate future and they are starting to take small steps toward behavior change
what is the definition of action
person had made changes in behavior
what is the definition of maintenance
people have maintain behavior change for 6 months and are trying to prevent relapse
whare are of skin does L4 cover
medial leg
anterior thigh
big toe
what area of the skin does L5 cover
lateral thigh
anterior leg
bottom and top of foot minus pinky toe and big toe
what area of skin does S4 cover
lateral leg and pinky toe
area around but hole
what area of skin does S2 cover
posterior medial leg
what area of skin does S1 cover
posterior lateral leg
are malaria vaccines effective against malaria all the time
will you see granulation on tissue for lung xray
what type of shock has high cardiac output
sepsis and anaphylaxis
what type of shock will have warm skin
sepsis and anaphylaxis
what type of shock will have dry skin
CNS injury
what type of shock will have increased pulmonary capillary wedge pressure and increased SVR
acute MI
valvular dysfunction
cardiac tamponade
What type of shock will have a decrease pulmonary capillary wedge pressure and SVR
hemorrhage, dehydration, and burns
what is seen with alcoholic hepatitis
mallory bodies
what are mallory bodies
intracytoplasmic eosiniphilic inclusions of damaged keratin filaments
what are the AST and ALT values seen with alcoholic hepatitis
AST greater than ALT
what happens to the CO2 level in COPD
chronic bronchitis
what do we give to increase BP with solution
0.9 percent saline
what is the mechanism of action of cyclosporine
suppressing the early response of T lymphocytes activation via preventing IL 2 transcription
decrease NFAT- nuclear factor of activated T cell
type type of blood smear is seen in HEELP syndrome
why can we get kidney stone with gout
the more uric acid we have in the blood the more that can be filtered into the kindey
are uric acid stones visible on x ray
what is the overall MOA of ezetimbe
inhibit cholesterol absorption in the entereocyte
what is the overall MOA of cholestyramine, colestipol, colesevelam
inhibit bile acid reabsorption
what is responsible for keeping the uvula midline
vagus nerve
what muscular byproduct can cause acute tubular necrosis
what structure will form with amyloidosis
abnormal aggregation of proteins into beta pleated linear sheets
what is lichen sclerosis
thining of skin in genital area
what is the sign of lead exposure in children
mental deterioration
what is the sign of lead exposure in adults
headache, memory loss, demyelination
what can chronic abuse of inhaled glue result in
broad based, ataxic gait
slow to answer questions
when do we see endometritis
inflammation of the endometrium, seen with things staying in the uterus that should not be there
promotes infection
what type of pain is characteristic in endometriosis
cyclic pain
what happens in the CI for odds ratio or relative risk contains 1
There is no difference between the groups
what happens if the CI for mean different between two groups contain 0
there is no difference between the groups
what will happen to the ovaries in PCOS
bilateral cystic ovaries
no pain with periods and light periods
what is at risk of getting damaged in the maxillary bone is damaged
inferior alveolar nerve
inferior alveolar artery
linginal nerve
what physical exam findings will be seen pleural effusion
tracheal deviation
percussion- dull
fremitis- decreased
tracheal deviation- none or away from side of lesion
what physical exam findings will be seen in consolidation aka lobar pneumonia or pulmonary edema
tracheal deviation
percussion- dull
fremitis- increased
tracheal deviation- none
late inspiratory crackles
what physical exam findings will be seen in bronchial obstruction
tracheal deviation
percussion- dull
fremitis- decreased
tracheal deviation- toward side of lesion
what physical findings will be seen in simple pneumothorax
tracheal deviation
percussion- hyperresonant
fremitis- decrease
tracheal deviation- none
what physical findings will be seen in tension pneumothorax
tracheal deviation
percussion- hyperressonant
fremitis- decrease
tracheal deviation- away from side of lesion
what can a kid do at 9 months
pincer grasp
separation anxiety
object permanence
what can a kid do by 15 months
when do babinski sign disappear
12 months
when do plamar sign disappear
6 months
when can a baby crawl
8 months
when can a baby lift head
1 month
what type of vaccine is given for rubella
live attenuated vaccine
what happens if there is homeobox mutation
appendages in wrong location
what is the function of homebox gene
segmental organization of embryo in the crainocaudal direction
what epithelial cell will be seen in ovary
simple cuboidal
what epithelial cell will be seen in fallopian tube
simple columnar
what epithelial cell is seen in uterus
simple columar
what epithelium is seen in ectocervix
stratified squamous non keratinized
what epithelium is seen in endocervix
simple columnar
what epithelium is seen in vagina
stratified squamous non keratinized
what is seen with DRESS syndrome
fever, lymphadenopathy, facial edema, diffuse skin rash, eosinophilia, and internal organ dysfunction
what is power and what does it mean
probability of rejecting a null hypothesis when it is truly false
how does the common peroneal/ fibular nerve get damage
fracture at neck of the fibula
what can AV fistula do in terms of afterload and preload
increase preload
decrease afterload
what are the signs of pudendal nerve injury
fecal and urinary incontinence, perineal pain, and sexual dysfunction
what test correlate with ESR
the acute phase reactant fibrinogen
what induces fibrinogen and other acute phase reactant
IL 6
what will be seen on light microscope 0-4 hours after MI
minimal change
what is seen on light microscope 4-12 hours after MI
early coagulation necrosis, edema, hemorrhage, wavy fibers
what is seen on light microscope 12-24 hours after MI
coagulation necrosis and marginal contraction band necrosis
what is seen on light microscope 1-5 days after MI
coagulation necrosis and neutrophilic infiltrate
what is seen on light microscope 5-10 days after MI
macrophages phagocytosis of dead cell
what is seen on light microscope 10-14 days after MI
granulation tissue and neovascularization
what is seen on light microscope 2 weeks- 2 months after MI
collagen deposition/ scar formation
what size is blastomyces fungi in relation to RBC
same size
what will be seen with CREST syndrome
anti- centromere antibodies
what does progesterone do to prolactin
negative feedback on prolactin via the anterior pituitary
what can you see in fever in children
how do you treat a fever in children
febrile seizure- benign
supportive care- acetaminophen or ibuprofen for comfort
what is concerning about heat stroke in children
can cause permanent end organ damage
how do you treat heat stroke in children
rapid external cooling
why do you give ibuprofen or acetaminophen to a child with fever
decrease fever and improve patient comfort by inhibiting synthesis of prostaglandin E2
reduces thermoregulatory set point
what is the mechanism of action for terbinafine
inhibit synthesis of fungal membrane ergosterol by suppressing the enzyme squalene epoxidase
what predisposes a patient to angiosarcoma
chronic radiation
what is angiosarcoma
rare blood vessel malignancy
usually in elderly and in sun exposed area
what is seen with NSAID associated chronic renal injury
chronic interstitial nephritis and papillary necrosis
what pathology is seen with noncaseating granuloma- Crohn or UC
what makes brown pigment gallstone
calcium salt and unconjugated bilirubin
how do we get the unconjugated bilirubin in brown pigment stones
beta glucuronidase
what liver changes are seen in Reye syndrome
microvesicular fatty change
what acts as the central regulator of iron
hepcidin- secreted by liver
what is the function of hepcidin
decrease iron absorption by degrading ferroportin
decrease iron release from macrophage
what is the function of ferroportin
transport intracellular iron to the circulation
what can cause acne in athletes
anabolic steroid
what is the description of acne
obstruction aka comedones
inflammation aka papules/ pustules, nodules, cyst
what is the most important thing to do to reduce risk of transmission of hospital acquired infection
hand hygiene
what is the cause of classic galactosemia
absence of galactose-1-phosphate uridyltransferase
what is the presentation of classic galactosemia
failure to thrive, jaundice, hepatomegaly, infantile cataracts, intellectual disability
can result in E coli sepsis in neonates
what is transference
unconscious shifting of emotions or desires from a person to the past to another person in the future
what enzyme can use GTP
phosphoenolpyruvate carboxykinase
what is effect modification
the effect of the main exposure on the outcome is modified by the presence of another variable
what are the drugs that prevent IL 2 transcription
what are the calcinuerin inhibitor
cyclosporine and tacrolimus
what are the mTOR inhibtor
how do we get rid of inorganic duct and fine size particles
alveolar macrophages
what removes deformed red blood cell from the body
red pulp of spleen
what is the issue with pyruvate kinase deficiency and the blood
cannot make ATP therefore get rigid RBC and extravascular hemolysis
what reaction needs biotin
pyruvate carboxylase
acetyl- CoA carboxylase
propionyl- CoA carboxylase
why is the hep C virus genetically unstable
lack of 3' to 5' exonuclease activity
what is anicteric hep A infection
silent or subclinical infection
what are koplik spots
small white, blue, or gray specks the erythematous base
what disease has koplik spots
measles virus
what type of rash is seen with measles
maculopapular rash that start at face and move down
what is the most common cause of calcium kidney stone
idiopathic hypercalciuria
will have normocalcemia
what indicates chronic elevation of pulmonary capillary hydrostatic pressure
hemosiderin- laden macrophages
golden cytoplasmic granules that turn dark blue with prussian blue staining
what is most commonly affected in anterior acute compartment syndrome of the leg
anterior tibial artery
deep peroneal nerve
what will be affected in the lateral compartment of the leg
superficial peroneal nerve
what will be affected in the deep posterior compartment
tibia nerve
posterior tibial artery
peroneal artery
what will happen to the dermis with cutaneous steroid
atrophy/ thinning of dermis
what is first line treatment for narcolepsy
modafinil or amphetamine
daytime stimulant
what can be used at night for narcolepsy
nighttime sodium oxybate
what is seen with HIV associated dementia
microglial nodules
what does HER2 oncogene code for
human epidermal growth factor receptor with tyrosine kinase actvitiy in the intracellular domain
cystinuria is what
defective transport of cystine, ornithine, arginine, and lysine
cause cystine stone
which type of ulcers are not malignant
those in the duodenum
why should you not mix metronidazole with alcohol
disulfiram like effects when combined with alcohol due to acetaldehyde accumulation
what causes Guillain-Barre syndrome
immune mediate, demylinating, due to molcular mimicry
what will the histology of guillain-barre show
inflammatory infiltrate in the endoneurium
what is unique about ecological studies
looks at populations and not individuals
what primary cell lines increase in COPD
neutrophils, macrophages, CD8 T lymphocytes
what bacteria do we need less of to infect a person
shigella flexneri
what is the substituation in sickle cell anemia
valine substitution for glutamic acid
what is the mutation in cystic fibrosis
phenylalanine deletion
if there was no surfactant, what would happen to the alveoli with
small spheres collapse before large ones
what will damage to the junction of anterior communicating artery and anterior cerebral artery result in
compress optic chiasm- cause bitemporal hemianopia
what will damage to the junction between the posterior communicating artery and internal carotid artery
oculomotor palsy
what can we give to decrease the progression of colon adenocarcinoma
Asprin/ a cox-2 inhibitor
what is p53
tumor suppressor gene
what is ras
what happens to urea when we add ADH
increase urea reabsorption in the medullary collecting duct
what is essential for the diagnosis for TTP
thrombocytopenia and microangiopathic hemolytic anemia
other than rouleaux formation and punched out lytic bone lesions, what else is multiple myeloma associated with
punched out amyloidosis
what is the type of pain when the visercal peritonium is affected
usually in the midline and is poorly localized
dull, constant, cramping quality
what type of pain is with parietal peritoneum
severe somatic pain that is more localized
what is middle meningeal artery a branch of
maxillary artery
how the middle meningeal artery enter the head
enter the skull at the foramen spinosum
deep to the pterion- where frontal, parietal, temporal, and sphenoid bone meet
what is the mechanism of action of ethosuximide
blocks thalamic T type Ca channels
what is the histology of cavernous hemangioma
variable size in vascular size lined by epithelial layer
what is cavernous hemangioma
benign liver tumor
what is the expression for heteroplasmy
maternally transmitted, variable expression
what is the MOA of fenoldopam
selective peripheral dopamine 1 receptor agonist
what does fenoldopam do
arteriolar dilation and renal vasodilation
what is the pathology of hyperchylomicronemia
lipoprotein lipase of apo C2 deficiency
what is the pathology of familial hypercholesterolemia
absent or defective LDL receptors
what is the pathology of hypertriglyceridemia
hepatic overproduction of VLDL
what is the presentation of Hep A
fever, anorexia, and dark colored urine
what is the liver biopsy for Hep A
hepatocyte swelling
monocyte infiltration
councilman bodies
what lab values are used in prognosis of those with cirrhosis
albumin levels
bilirubin levels
prothrombin level
what is seen with crirhosis
diffuse bridging fibrosis via stellate cell and regenerative nodules
what is seen with follicular lymphoma
waxing and waning lymphadenopathy
what does abnormality in I and aVL indicate
lateral infarct
Left circumflex artery
what does a defect in V1 to V6 imply
left anterior descending artery infarct
what is the strongest risk factor for suicide
previous suicide attempt
what parts of the nephron are not permeable to water
thick and thin ascending limb of Henle's loop and early DCT
what does etoposide and teniposide inhibit
topoisomerase II
what does irinotecan and topotecan inhibit
topoisomerase I
what types of breaks do irinotecan and topotecan result in
single strand breaks in DNA
what is the cell type seen with coccidiodomycosis
spherules that are much larger than RBC filled with endospores
what will the small bowel mucosa look like for those with primary lactase def
what is affected if ornithine cannot be transported from the cytosol to the mitochondria
cannot excrete ammonia- need to restrict protein intake
what is seen in fluminant/ sudden hepatitis
increased AST and ALT and increased prothrombin time
what can help determine cause of metabolic alkalosis
volume status
urinary chloride
what cause damage to the long thoracic nerve
axillary node dissection after mastectomy
stab wounds
what is the staining seen with eosinophilic granulomatosis with polyangiitis
p ANCA aka anti myeloperoxidase
what is pure red cell aplasia
low erythroid element and normal everything else
what is associated with pure red cell aplasia
lymphocytic leukemia
parovirus B19
what type of arteriolosclerosis is seen in severe hypertension
onion skinning in small arteries and arterioles
what is the most common benign lung tumor
hamartoma aka pulmonary chondroma
what is in a hamartoma
hyaline cartilage, fibrous and adipose tissue
how do you treat adrenal crisis
high flow intravenous fluid
what indicated irreversible cell damage
appearance of vacuoles and phospholipid- containing densities within mitochondria
what type of virus is parovirus
non enveloped single strand DNA
is nuclear chromatin clumping reversible or irreversible
where does complement bind to the immunoglobulin
C1 bind to the Fc region of the heavy immunoglobulin chain in the region near the hinge point
what is trastuxumab
monoclonal antibody
block the HER2 tyrosine kinase receptor
what are side effects we should be concern about with first generation AS low potency drug
sedation from antihistamine
anticholinergic effect
block alpha 1- orthosatic hypotension
what are the side effects we should be concern about with first generation AS high potency drug
extrapyramidal symptoms
what does shiga like toxin from EHEC E. Coli do
inactivate the 60s ribosomal subunit in human cells
what is unique about EHEC compared to other E coli strains
does not ferment sorbitol during overnight incubation
does not make glucuronidase
what does alpha hemolysis mean
partial aka green hemolysis
what does naloxone bind the strongest to
mu opiod receptor
what is the presentation of von Hippel- Lindau disease
bilateral renal cell carcinomas
what is the presentation of sturge weber syndrome
port wine stain on CN V1/V2 on face
tram track skull appearance
what is the appearance of granulosa cell tumor
call-exxaner bodies
granulosa cells arranged haphazardly around collections of eosinophilic fluid
what happens to the esophagus in CREST syndrome
atrophy and fibrous replacement of the muscularis in the lower esophagus
what is elevated pH in the vagina associated with
bacterial vaginosis
trichomonas vaginitis
mast cell proliferation is associated with which mutation
KIT receptor tyrosine kinase
where can we see an absence of submucosal and myenteric plexi
how do we treat delirium
low dose antipsychotic
what quality in drugs can allow for hepatic metabolism
lipophilic drugs
where does the psoas muscle originate from
anterior surface of the transverse process and lateral surface of the vertebral bodies
what do we use matching for in study design
control for confounding varaible
what is contraction in cardic and smooth muscle dependent on
extracellular calcium influx through L type calcium channel
what is the contraction of skeletal muscle dependent on
action potential going down muscle and mechanically opening sarcoplasmic reticulum
what is the sign of a psoas abscess
patient does not want to extend hip
back/ flank pain
what is a compound nevi
in both the dermal and epidermal
cells are not replicating
what are junctional nevi
cells clump at dermoepidermal junction
what type of melanocytic nevus are papular with NO pigment
intradermal nevi
what causes left ventricular outflow tract obstruction in a patient with hypertrophic cardiomyopathy
anterior leaflet of the mitral valve shift towards the aortic valve due to the interventricular septum
what describes yeast with a broad based budding
what is trousseau sign and what is it associated with
migratory superficial thrombophlebitis
superficial thrombosis that happen in one place, resolve, then go to another place
associated with visceral cancer
what are calcium sensing receptors
G protein coupled receptors
why are patients with Crohn disease affecting the ileum cause gallstone
decrease bile reabsorption result in cholesterol supersaturation of the bile, results in gallstone
what is the posterior descending artery supply
posterior wall of ventricle
what are findings that make us think about rubella and not rubeola aka measles
both have a maculopapular rash that begin at face and spread to trunk
postauricular lymphadenopathy indicate rubella
what is methadone
long acting opiod agonist
which mitochonidral enzyme activates caspases
cytochrome c
what is the target of infliximab
IgG1 monoclonal antibody to TNF alpha
what is the target for rituximab
monoclonal antibody against CD 20 antigen
what is only seen in the nucleolus
RNA polymerase I
what is the function of nucleolus
ribosomal subunit maturation and assembly
what is the presentation of leukocytoclastic vasculitis
cutaneous small vessel vasculitis seen with medication
a lot of neutrophils present and fibrinoid necrosis
what is the presentation of legg calve perthes disease
in young kids
idiopathic osteonecrosis of the hip
what is the presentation of mccune albright syndrome
fibrous dysplasia of the bone
endocrine abnormalities
cafe au lait spots
what is the histology of cardiac amyloidosis
myocardium infiltrated by an amorphous and acellular pink material
what is globus sensation
feeling of lump in your throat with any physical findings, endoscopic, or radiographic findings of esophageal obstruction
what is a sensitive indicator for apoptosis
DNA laddering, fragments in multiples of 180
what is the concern with anterior or posterior dislocation of the knee joint
popliteal artery
what is displacement example
mothers yells at child because husband yelled at mother
what is an example of sublimation
teenager aggression towards someone is redirected to do well at sports
what happens when a ligand binds to tyrosine kinase receptor
formation of receptor dimers and conformation change that exposes tyrosine kinase active site
what is an example of reflection interview
repeat what the patient has said to confirm understanding
what is an example of confrontation interview
draw patient's attention to discrepancies in statements behavior
physician point out the denial of patient's drinking problem
what are the signs of intranasal cocaine abuse
chronic nasal discharge, atrophic nasal mucosa, thinning of the nasal septum which can lead tp perforation
what will happen to the GFR if we remove one kidney
initially GFR will be 50 percent but will go up to 80 percent of original
where does phosphodiesterase 5 inhibitor act on penis
corpora cavernosa
what is the difference in PTSD and acute stress disorder
acute stress disorder is less than a month
what disease will have agenesis of the cerebellar vermis
dandy- walker syndrome
what disease is associated with a low lying cerebellar
chiari malformation
what type of cancer are head and neck cancer
squamous cell carcinoma
what is the defect in pseudohypoparathyroidism
defective Gs protein alpha subunit causing end organ resistance
what do we add to ELISA once we put the sample in and wash
anti human IgG antibody coupled to peroxidase
what are used in bacterial antibiotics efflux pump
sodium gradient
proton electrochemical gradient
what is the issue with bruton agammaglobulinemia
intracellular messaging abnormality
defect in BTK- tyrosine kinase gene
no B cell maturation
issue with X chromosome
what is used to to allow protein to target the RER
N terminal peptide signal sequence
What cofactor do we need to break down branched amino acid
thiamine aka B 1
what is Ras
GTP binding, signal transducing oncoprotein
what is the biggest risk factor for osteoarthritis
what allows for translation in an apoptic cell
internal ribosome entry site
what helps initiate 5' cap dependent translation in eukaryotic organisms
kozak consensus sequence
what help initiate 5' cap dependent translation in prokaryotes
shine- dalgarno sequence
where do we most likely see crohns
in the terminal ileum
what does the recurrent laryngeal nerve innervate
intrinsic muscles of larynx but cricothyroid
where do DNA virus replicate, what is the exception
nucleus, poxvirus replicate in cytoplasm
where do RNA virus duplicate, what are the exceptions
cytoplasm, except orthomyxovirus and retrovirus
what is intellectualization entail
use excessive thinking to avoid painful emotions or fears
what causes achalasia
degeneration of inhibitory ganglion cells in the myenteric plexus
are postganglionic autonomic neurons myelinated or not
not myelinated
what skin disease is seen with celiac disease
dermatits herpretiformis- pruitic rash
what determines cellular differentiation
transcription factor
what is recommmended medication for those with mechanical valve
what is leuprolide
GnRH analog
continuous use aka loss of pulsitile use result in low FSH and LH
in the fetal circulation, how does blood go from the liver to the IVC which will bypass hepatic cirulation
via ductus venosus
what is the form of aspergillus on staining
broom like
what can mutations in homebox gene result in
hypoplastic first digits and genitourinary malformation
how does max velocity of skeletal muscle increase
as afterload decreases
what is the opening of the maxillary sinus
middle nasal meatus
when do we see supraclavicular lymph node get enlarge
abdominal malignancies, breast cancer, lung cancer, lymphoprolierative disorder
what comes out of the jugular foramen
CN IX, X, XI, and jugular vein
what are three things that can be made from POMC
beta endorphins, ACTH, and MSH
what are stop codons- there are three
what is the direction of translation of mRNA template
5' to 3' direction
what makes propionyl-CoA
odd chain fatty acids
what is the function of theca interna
respond to LH
convert cholesterol to androgens
what is the function of granulosa cells
respond to FSH
androgens to estrogen
when is aortic regurg the loudest
right after aortic valve close
what is the histology seen in leukemoid reaction
basophilic oval inclusions aka granules known as Dohle bodies in mature neutrophils
increased bands
early mature neutrophilic precursors aka myelocytes
what is the association for liver angiosarcoma
arsenic, vinyl chloride
positive for CD 31
what will happen in papilledema
increased intracranical pressure which result in impaired axoplasmic flow and optic disc edema
what is the presentation of idiopathic intracranial hypertension
young obese women with daily headache and transient visual disturbances
worsen during valsalva aka bending down or coughing
what is the first step in infective endocarditis
disruption of normal endocardial surface which result in focal adherance of fibrin and platelet which result in a sterile fibrin platelet nidus
what happens to diffuse capacity for carbon monoxide in COPD
what happens to diffuse capacity for carbon monoxide in asthma
what structure on vasculature is responsible for WBC traveling between endothelial cell and exit blood vessels
what structures on vasculature are responsible for tight bindings in the leukocyte extravasation process
what structures on vasculature are responsible for rolling in leukocyte extravastion process
E selectin
P selectin
where in the renal tubule in PAH concentration lowest
bowman capsule
what is the histology of myxomas
scattered cells within a mucopolysaccharide stroma, abnormal blood vessels, and hemorrhaging
what does damage to the posterior inferior cerebellar artery result in
vertigo/ nystagmus
loss of pain and temperature ipsilateral face and contralateral body
ipsilateral horner syndrome
dysphagia and hoarseness
what is the importance of folate in DNA and RNA
needed for the synthesis of nitrogenous base in RNA and DNA
What causes sudden relaxation when the muscle exerts too much force
golgi tendon
what skin pathology is associated with bartonella hensealae
bacillary angiomatosis
benign capillary skin papules
what are insulin mediate glu channels and in what organ
muscle cells
what are insulin independent glut channels and in what organs
Glut 1,2,3,5
what sugar is metabolized the fastest and why
fructose phoshphorylated into fructose 1 phosphate
bypass phosphofructokinase 1- the rate limiting step of glycolysis
what is a cross over study
subjects are randomly allocated to a sequence of 2 or more treatment given consecutively
what percipitates encephalopathy in chronic thiamine deficiency
glucose without thiamine
this is becasue thiamine is a cofactor for enzyme in glucose metabolism
what disease is associated with polyarteritis nodosa
hep B
how do we get resistance to aminoglycoides
aminoglycoside modifiying enzymes
mutated ribosomal subunit
mutated porin protein
what is the function of cilostazol and dipyridamine
phosphodiesterase inhibitor
inhibition in platelet aggregation
arterial vasodilator
what capsule is made in bacillus anthracis
antiphagocytic D glutamate capsule
what is the major cause of death in those recovering from subarachnoid hemorrhage
severe vasoparam
hence why we give nimodipine after SAH
what is increasing afterload do to murmur in HCM
decrease murmur
why do we need an Hep B infection to get Hep D
hep B coats hep D
what is the difference in function between the flexor digitorum profundus tendon and the flexor digitorum superficiais tendon
the flexor digitorum profundus tendon can flex the DIP
what is the issue with leukocyte adhesion deficinecy
defect in LFA-1 integrin
what will be seen in leukocyte adhesion deficincy
cannot remove umbilical cord
absent pus
increase neutrophi in blood and non at site of infection
what is the period that we have the greatest teratogen susceptability
week 3-8
what is the glisson capsule made out of
how long do you have to wait since last seizure that you are able to drive
6 months seizure free
what will create a bulge in the anterior vaginal wall
cystocele- prolapse bladder
what is the findings of uterine prolaspe
bulge in the vagina
what is the presentation of langethans cell histocytosis
lytic bone lesion
skin rash
recurrent otitis media
mass involving mastoid bone
what do the cells express in langerhans cell histocytosis
S-100- mesodermal origin
what is seen in EM of langerhans cell histiocytosis
birbeck granules aka tennis racket
what will be seen with hysterosalpingogram with contrast
some spillage of contrast which is normal
what is seen with radiation to the lymph nodes
contraction of lymph nodes due to fibrosis
what is the function of colipase
prevent the inhibitory effect of the bile salts on the lipase catalyzed intaduodenal hydrolysis of dietary long chain triglycerides
do pancreatic lipase need to be cleaved before activated
what helps improve the activity of pancreatic lipase
what is the equation of relative risk
risk of disease in exposed group/ risk in unexposed group
what is the equation of relative risk reduction
what happens to methylmalonic acid and homocysteine if there is less folate aka B9
methylmalonic acid is normal
homocysteine is increased
what happens to methylmalonic acid and homocysteine if there is less B12 aka cobalamin
increase homocysteine
increased methylmalonic acid
what type of hypersensitivity is post strep glomerulonephritis
type III immune complex mediated
in what pathology do we see an increased number of megakaryocytes in the bone marrow
immune thrombocytopenia
what is the antibodies in immune thrombocytopenia
anti Gp IIb/IIIa
what is the unique feature of trigeminal neuralgia
last less than 60 seconds
what point of the nephron is affected by dehydration or too much water
collecting duct
what is seen with liquefactive necrosis
bacterial abscess
brain infarct
what is seen in coagulative necrosis
ischemia/ infarcts in everywhere but brain
what is the defect in congenital QT prolongation
outward K channel
what is the cause of concentric hypertrophy
increase pressure/ hypertesnion
how are sarcomere added in concentration enlargement
in parallel
what is the findings in solar elastosis
elastin are fragmented
what is seen in PCOS
what is the lab findings in prerenal azotemia
bun/creatinine= over 20
FENa is less than 1 percent
what is the lab findings in intrinsic renal azotemia
FENa is greater than 2 percent
serum BUN/ Cr is less than 15
what antibody attaches to the Fc part of mast cell or basophil
what antibody causes complement activation
IgG or IgM
what is unconjugated bilirubin
lipophilic material
what is conjugated bilirubin
water soluble
where will we see beryllosis
on top of lung
what is the function of red pulp in the spleen
filter blood of antigens and bad things
take out old RBC
where do we see a meckel diverticulum
terminal ileum
what do we see meckel diverticulum
ectopic acid- secreting gastric mucosa and/ or pancreatic tissue
how do we diagnose meckel diverticulum
technetium 99 pertechnetate
what type of diverticulum is meckel
true diverticulum
all 3 gut walls
what type of murmur will show abnormally brisk upstroke and the downstroke
aortic regurgitation
what will be see with aortic reguritation
head bobbing
1 g of protein has how many calories
4 calories
what is the ratio we look for in respiratory distress syndrome
lecithin- sphingomyelin ratio of over 2
what is a lecithin a part of
what type of capsule is rotavirus
helical virus and way to remember it
Corona ?C?
Bunya, Arena, Detta ?BAD?
Paramyxo, rhadbdo, orthomyxo, filo ?PROF
what is the most abundant amino acid in collagen
what is the genetics behind hemoglobin C
missense mutation
replace glutamate with lysine
decrease in negative charge
what is the distinguishing feature of pasteurella
mouse like order aka indole positive species
after dog bite
what causes the conversion between T4 to T3
iodothyronine deiodinase
what is the function of TPO aka thyroid peroxidase
thyroglobulin iodination
what is the function of metalloproteinase
normal tissue remodeling
basement membrane penetration
what will activate T helper subtype 1 cell
intracellular pathogens like legionella and mycobacterium tuberculosis
what is the presentation of kawasaki disease
fever more than 5 days
bilateral conjunctivitis
asian kid
non pitting edema in arm and leg
cervical lymphadenopathy
what is the complication of kawasaki disease
coronary artery aneurysm
what is the presentation of subclavian steal syndrome
stenosis of proximal subclavian
leads to reversal in blood flow from the contralateral verterbal artery to the ipsilateral vertebral artery
where is aortic stenosis loudest
at heart base
crescendo- decrescendo systolic ejection murmur
what antibody can cross the placenta
what type of antibody are seen with those in blood groups A and B
what antibody is seen with those with blood group O
what is the other treatment for lyme disease other than doxycycline
penicillin- type antibiotics
what do CNS tumor that stain with synaptophysin possibly contain
presynaptic vesicles in neurons
neuroendocrine cell
what causes urinary incontinence in whose with normal pressure hydrocephalus
stretching of descending cortical fibers
at what pH do we have uric acid stone
low urinary pH
what does cortisol do interms of helping with the use of NE
permissiveness- cortisol improves the action of NE
what is the definition of additive effect
effect of substance A and B together is equal to the sum of their individual effect
what is the definition of synergistic effec
the effect of substance A and B together is greater than the sum of their individual effects
what is the definition of tachyphylactic
acute decrease in response to a drug after initial/ repeated administration
what is an example of additive drug interactions
aspirin and acetaminophen
what is an example of permissive drug interactions
cortisol and catecholamine
what is an example of synergistic drug interactions
clopidogrel with aspirin
what is an example of tachyphylactic drug effect
what is the function of obturator nerve
thigh adduction
what does the inferior gluteal nerve do action for
extension of thigh
what is a complication of acute pancreatitis
pancreatic pseudocyst
what lines the pseduocyst
granulation tissue and fibrosis
what is the course of the median nerve
between humeral and ulnar heads of the pronator teres muscle and then runs between the flexor digitorum superficialis and the flexor digitorum profundus
what is the result of rubella in adult
polyarthritis and polyarthralgia
what is the result of rubella in children
sensorineural deafness, cataracts, and cardiac malformations
what is seen with uncal herniation
ipsilateral CN III palsy
how do we get uncal herniation
push brain pass tentorium cerebelli
what is systolic heart failure findings
reduced ejection fraction
increased end diastolic volume
decrease contractility
what is the diastolic heart failure findings
preserved ejection fraction
normal end diastolic volume
decreased compliance
what is the vaccine for neisseria meningitidis
capsular polysaccharide
what type of vaccine for influenza
inactivated aka killed organisms
what is the action of calcipotriene
activates nuclear transcription factor vitamin D receptor
inhibition of keratinocyte proliferation and stimulation of keratinocyte differentation
what is the most important poor prognositc factor of post strep glomerulonephritis
increased age
what is the cause of oxygen induced hypercapnia in COPD
increase in physiologic dead space
what is heard with mitral valve stenosis
opening snap followed by a diastolic rumbling murmur heard best at apex of the heart
heard shortly after S2
what is the action of dobutamine
increased HR and contractility
leading to an increase in myocardial oxygen consumption
what is hibernating myocardium
presence of left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization
what predisposes a person to primary sponsubtaneous pneumothorax
apical subpleural bleb or cyst- if they rupture it is bad and cause pneumothorax
what is the kocak sequence
R is adenine or guanine
what does the smooth ER do
steroid hormone synthesis
Lipid synthesis
carbohydrate metabolism
drug detoxification
what is the function of RER
secretory protein
N link oligosacchardies addition to protein
nissel bodies are the RER in neuron
what does the nissl bodies do
RER in neurons
make peptide neurotransmitters for secretion
where is the main action of PCP
N methyl D aspartate receptor antagonist
what are the signs of PCP intoxication
psychommotor agitation
vertical nystagmus
C. difficile infection damage what part of intestinal mucosal cell
cytoskeleton via actin depolymerozation
cause pseudomembrane
what part of the brain makes norepinephrine
locus ceruleus
posterior rostral pons near the lateral floor of the fourth ventricle
what are langerhans cell
dendritic cell found in skin that act as antigen presenting cell
what happens to aterial blood and venous blood oxygen and CO2 levels when we workout
aterial blood- no change
venous blood- oxygen decrease, CO2 increased
how do non pathogenic corynebacterium cause severe pseudomembranous pharyngitis
getting the Tox gene via lysogenization by temperate bacteriophage

tox gene encodes diphtheria AB exotoxin
what does aldosterone receptor antagonist do in the collecting duct
decrease H and K secretion
what does aldosterone do to the collecting duct
Na reabsorption
K excretion
H excretion
what is the most common cause of hypochromatic microcytic anemia
iron deficiency via occult blood loss
what so we use primaquine for
kill P vivax and P ovale liver hypnozoites
what is winter formula
PaCO2= 1.5 x HCO3+ 8+/- 2
what is paraneoplastic cerebellar degeneration
autoimmune response
immune response against tumor cell that cross reacts with Purkinje neuron antigens
anti-Yo, anti- P/Q, and anti-Hu are the common antibodies detected in the serum
what is the appearance of fat emboli on lung
stain black with osmium tetroxide
what is the common cause of DIC in pregnancy
due to release of tissue factor from injured placental
what familial dyslipidemia can result in premature coronary artery disease
familial hypercholesterolemia
what is the main cause of mitral stenosis
rheumatic fever
what are liposarcoma
has lipoblast and are malignant
has non membrane bound cytoplasmic lipid
what is the pathophysiology of dermatitis herpetiformis
deposits of IgA at tips of dermal papillae
what is damaged in Wernicke encephaolopathy
mammillary bodies
what is the presentation of wernicke encephalopathy
encephalopahty- memory loss
oculomotor dysfunction
what is damaged in kosakoff syndrome
anterior and medial thalami
what is the presentation of Korsakoff syndrome
preserved long term memory
what happens to the coronary artery in hypertrophic cardiomyopathy
they are normal
what is the S2 heart sound
aortic and pulmonic valve closure
what is the S1 heart sound
mitral valve close
what does DNA polymerase I have that is unquie compared to DNA polymerase III
5' to 3' exonuclease activity to remove RNA primer
what part of DNA repair is affected in Lynch
mismatch repair genes leading to micro satellite instability
what is a concerning side effect of cyclosporine and tacrolimus
is sirolimus nephrotoxic
what is the MOA of metoclopramide
D2 receptor antagonist, used to treat vomiting or diabetic/ post surgery gastroparesis
what is the contradiction for metoclopramide
Parkinson due to D2 receptor blockage
small bowel obstruction
what electrolyte accumulation is the hallmark for ischemic injruy
cytoplasmic Ca accumulation
how do you distinguish between Marfan and homocystinuria
homocystinuria patient will also present with intellectual disability, hypercoagulability, and downward lens dislocation
what is the defect and buildup in homocystinuria
cystathionine-beta- synthase
buildup of methionine and homocysteine
what drugs cross the palcenta
lipophilic drug
what drug has a higher binding for albumin- warfarin or heparin
what is the definition for re-assortment
mixing of genomic segments in segmented virus that infect the same host cell
what is seen on ECG for hyperkalemia
peaked T waves
what is seen in hypokalemia on ECG
QT prolongation
appearance of U wave
ST segment depression
what is seen in the regenerative nodules in liver cirrhosis
proliferating hepatocytes
why do we get lactose intolerance
normal downregulation of lactase by small intestinal enterocytes and a decrease in gene expression
what are the risk factor for papillary carcinoma
previous radiation
what is kluver bucy syndrome, what brain structure is affected
disinhibited behavior- hyperphagia, hypersexuality, hyperorality
what is the first line treatment for acute low backpain that is uncomplicated
what is the function of dopamine beta hydroxylase and what co factor does it need
convert dopamine to NE
needs vitamin C
what will happen with midshaft fracture of humerus
damage to the radial nerve
wrist drop
tripceps brachii are spared
what is the idea for skewed X inactivation
to compensate for additional X chromosome, one X is inactivated in each somatic cell
inactivation is random to each cell- but if inactivation is skewed to one certain X than women may present with X recessive disease
what microbe use RNA dependent RNA polymerase
genome replication of single and DS RNA virus
what are negri bodies and what disease do we see them in
eosinophilic neuronal cytoplasmic inclusions
what will acitertin
retinoid- a vitamin A derivative, can be used in psoriasis and acne
what is the mechanism of action of orilstate
inhibits intestinal lipase- results in decreased intestinal fat absorption
what is the effects of orlistat
used in weight loss but can a lot of adverse GI side effects like flatulence and diarrhea
what does insulin do in terns of fructose 2,6 bisphosphate level
increases it to encourage glycolysis
what happens if we have low fructose 2,6 bisphosphate
more gluconeogenesis
what veins drain into the cavernous sinus
facial vein via superior and inferior ophthalmic vein
cerebral vein
what is the issue with xeroderma pigmentosum
nucleotide excision repair
what is the issue with ataxia telangiectasia
non homologous end joining
what causes spider angiomas in cirrhosis patient
excess estrogen
what does neurofibroma contain
schwann cells, fibroblast, neurites
what is associated with endometriosis-infertility or endometrial carcinoma
what is the endoscopy results of ulcerative colitis
erythematous, edematous, friable, and granular mucosa

neutrophil in crypt- cause crypt abscess
why do we add sirolimus to stents
inhibit mTOR
without mTOR you block cell cycle between G1 and S phase to reduce smooth muscle proliferation
how does insulin increase cellular uptake of glucose in adipocytes and skeletal muscle
increase translocation of the protein to the cell membrane
what draws the distal clavicle fracture inferolaterally
what draws the proximal fragment of clavicle superomedially
what skin is innervated by the deep peroneal
skin between big and 2nd toe
what skin is innervated by common peroneal nerve
lateral leg
dorsolateral foot
what will defective proline hydroxylase result in
abnormal triple helix formation
where can pus from a psoas major muscle go to
abscess in the groin
what affects the DIP- RA or osteoarthritis
where does the copper deposit on the eye in Wilson's disease
Descemet's membrane
what is made by the telencephalon
cerebral hemispheres
lateral ventricle
what is made by the diencephalon
3rd ventricle
what is made by the mesencephalon
what is made by the metencephalon
upper 4th ventricle
what is made by the myelencephalon
lower 4th ventricle
what entails the prosencephalon
what entails the rhombencephalon
what is the use of a leucine zipper
transcription factor
what is the first step of de novo pyrimidine synthesis
carbamoyl phosphate synthase II creating carbamoyl phosphate in the cytoplasm frmo CO2 glutamine and ATP
what is the most effective way to prevent MI
what nerves have pass through the esophageal hiatus
anterior and posterior vagus nerver
what is way to remember P450 inducers
chronic alcoholics steal phen-phen and never refuse greasy crabs
what are the P450 inducers
chronic alcohol use
st john's wort
what are the P40 inhibtors
acute alcohol use
cimetidine/ ciprofloxican
isoniazid aka INH
grapefruit juice
what is the way to remember the inhibtors of P450
what is the most common cause of compression of the L5 or S1 nerve roots
acute lumbosacral radiculopathy
vertebral disc herniation
therefore a prolapsed nucleus pulposus
what is vasogenic edema
infarction or neoplasm destroys endothelial cell tight junction
what is the cause reactive arthritis
urogenital infection
intestinal injection

arthritis, urethritis, and conjunctivitis
what type of cells is in the transformation zone
stratified squamous epithelium and simple columnar
how does tetanus cause muscle spasm
exotoxin mediated loss of inhibition on alpha motorneurons
would we see anti-HBc IgG with vaccination
how do you get rid of cholesterol gallstones
hydrophilic bild acids
what skin lesion can result from pseudomonas aeruginosa
ecthyma grangrenosum cutaneous necrotic disease
what should we screen forwith steptococcus gallolyticus
colonic malignancy
coronal brain slice putamen
what is needed in normal renal development
angiotensin II
what causes a drug to have a low volume of distribution
high molecular weight
high plasma protein binding
high charge
what is the gross anatomy of celiac disease
increased intraepithelial lymphcytes
loss of villus height
crypt hyperplasia
malabsorption- steatorrhea
what gene mutation is associated with melanoma
what is affected in Duchenne muscular dystrophy and Becker
provide mechanical stability to sarcolemma
anchor muscle fibers
connects intracellular cytoskeleton actin to the transmembrane protein alpha and beta dystroglycan
what is the defect in PKU
decrease phenylalanine hydroxylase or BH4
what is the presentation of phenylketouria
intellectual disability
growth retardation
fair skin
musty body odor
what is the action of cinacalcet
activates the calcium sensing receptor in the parathyroid gland and decrease PTH release
what is the action of calcitriol
active form of vitamin D
what will cause an increase in creatine kinase
damage to the cell membrane- cause creatine kinase to leak out
which NF is associated with bilateral acoustic neuroma
what is the signs of atypical depression
increased appetite and sleep
leaden paralysis
rejection sensitivity
mood reactivity
what lies anterior to the third part of the duodenum
superior mesenteric vessels
what is the course of the great sapheno